Table 6.

Articles related to methods for addressing medical fraud and abuse

Method of Addressing Fraud	Study Type	Study Population	Article Title	Country	Year	Author
Interventions aimed at preventing healthcare fraud: cultural change, internal control improvement, legal actions (fines and legal penalties)	A Systematic Review of Literature	Articles assessing the effectiveness of any intervention to combat health care fraud were eligible for inclusion in our review from 1975 to 2008	No Evidence of the Effect of the Interventions to Combat Health Care Fraud and Abuse: A Systematic Review of Literature [28]	Iran	2012	and et al. Arash Rashidian
CHIP Reauthorization Act of 2015; focused efforts to curb drug diversion and fraud related to prescriptions, insurance limitations, and restricted pharmacy allocation	Systematic review	Describe the types and trends of Medicare and Medicaid fraud	Recommendations to protect patients and health care practices from Medicare and Medicaid fraud [23]	USA	2003	and et al. Zhen Xing Chen
Prison sentences, fines, license revocation, temporary ban on medical practice	Systematic review	Health Insurance	Major Types of Health Insurance Frauds And Their Punishments [39]	USA	2019	Wilson J
Defining intersectoral collaboration between all relevant institutions involved in fraud and abuse control, including audit departments, management evaluation, and control agencies; patient education and empowerment	Book	Medicare and Medicaid	Medicare and Medicaid: CMS needs to fully align its antifraud efforts with the fraud risk framework [40]	USA	2017	Hugues Dumont
Verbal reprimand, written warning with record in employment history, temporary ban (3 months to 5 years) from practicing in the medical field, permanent ban	Literature review	Medicare fraud and abuse related to Mohs surgery	Avoiding and managing Medicare fraud and abuse investigations of Mohs surgery: Mohs in the crosshairs [41]	USA	2018	Jay Wolfson and et al.
Enforcing legal regulations, implementing incentive and penalty schemes for physicians and pharmacies, strict legal sentences for fraudsters	Scoring model	National Health Insurance Corporation for outpatient care during the 3 rd quarter of 2007	A scoring model to detect abusive billing patterns in health insurance claims [42]	USA	2012	Hyunjung Shin and et al.
Guidelines for handling fraudsters by regulatory bodies, heavy penalties	Survey	Five electronic commerce systems; which are credit card, telecommunication, healthcare insurance, automobile insurance and online auctio	Fraud detection system: A survey [38]	Malysia	2016	Aisha Abdallah and et al.
Civil and criminal liability, anti-fraud programs, privacy protection of identity and medical records, preventing patient referrals to centers where the physician has financial interests	Meta-analysis	Eighty eight literatures obtained from journal articles, conference proceedings and books based on their relevance to the research problem were reviewed	Meta-analysis of fraud, waste and abuse detection methods in healthcare [19]	Nigera	2019	and et al Rhoda Ikono
Formation of fraud detection workgroups, syndicate action against fraudulent healthcare centers	machine learning and Data maining and developed framework	Leading insurance companies in Turkey (Company ABC)	An interactive machine-learning-based electronic fraud and abuse detection system in healthcare insurance [37]	Turkey	2016	and et al. Ilker Kose