Medical identity fraud is a byproduct of identity theft; it enables imposters to procure medical treatment, thus defrauding patients, insurers, and government programs through forged prescriptions, falsified medical records, and misuse of victim's health insurance. In 2014, for example, the United States Government lost $14.1 billion in improper payments. The purpose of this multiple case study, grounded by the Health Insurance Portability and Accountability Act as the conceptual framework, was to explore the strategies 5 healthcare leaders used to prevent identity theft and medical identity fraud and thus improve business performance in the state of New York. Data were collected using telephone interviews and open-ended questions. The data were analyzed using Yin's 5 step process. Based on data analysis, 5 themes emerged including: training and education (resulting to sub-themes: train employees, train patients, and educate consumers), technology (which focused on Kiosk, cloud, off-site storage ending with encryption), protective measures, safeguarding personally identifiable information, and insurance. Recommendations calls for leaders of large, medium, and small healthcare organizations and other industries to educate employees and victims of identity theft because the problems resulting from fraud travel beyond the borders of medical facilities: they flow right into consumers' residences. Findings from this study may contribute to social change through improved healthcare services and reduced medical costs, leading to more affordable healthcare.

The medical scheme industry in South Africa is competitive in relation to international standards. The medical scheme sector, as part of the healthcare industry, is negatively affected by the high rate of fraud perpetrated by providers, members and syndicates, which results in medical schemes funding fraudulent claims. The purpose of the study was to explore strategies to mitigate fraud in medical scheme claims. A qualitative research methodology was followed in this study, which adopted a case study approach. Empirical data was analysed through thematic analysis, with the aid of ATLAS.ti software. The study found that healthcare service providers mainly defraud medical schemes by submitting false claims. A holistic approach should be followed to mitigate fraud in medical scheme claims. This approach should encompass regularly identifying trends in fraudulent claims and implementing appropriate control strategies. Collaboration within the medical scheme industry and with other stakeholders would also help to elevate the fight against medical scheme fraud to a new level. Implementing the recommendations from the study will assist medical schemes to reduce the funds expended on fraudulent claims, thereby improving their financial viability and decreasing the rate of increase in medical scheme contributions for members. / Business Management / M. Com. (Business Management)