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For Educators

Broken Promises
Fraud by Small Business Health Insurers
Robert Tillman

Northeastern Series on White-Collar and Organizational Crime

Northeastern University Press
1998 • 256 pp. 1 table. 6 x 9"
Criminal Justice / Criminology / Security Studies

$24.95 Paperback, 978-1-55553-375-5

A much-needed study of insider health insurance fraud.

As the costs of medical care have skyrocketed, so has the amount of money lost to fraudulent health insurance providers. These bogus operations typically victimize individuals on the lower end of the socioeconomic scale who then face staggering medical bills without coverage.

Robert Tillman shows how market conditions and weak regulatory structures have allowed these crimes to occur, and cites recent institutional and legal changes that have created both new demands for insurance and greater opportunities for fraud. He also analyzes the political and economic climate that enables these criminal practices to flourish.

Drawing on court documents, congressional hearings, and actual cases, Tillman provides numerous examples of the three most prevalent forms of fraud: scams involving multiple employer welfare arrangements, employee leasing schemes, and fictitious labor unions. He also examines recent innovations in insurance fraud such as “24-hour plans” and coverage offered by dubious religious organizations.

With the regulation of health insurance currently in chaos, Broken Promises offers a critical examination of this insidious form of white-collar crime. It is a timely book that raises important questions about the definition of insurance and consumer protection.

Wed, 6 Jun 2012 15:29:52 -0500