Physicians are not allowed to refer patients to institutions, such as home-health providers, that they own a stake in ¡V should this law be extended to hospitals as well?…
References: Center for Disease Control and Prevention. (December 13, 2002). Morbidity & Mortality Weekly Report (Version 51(49);1109-1112) [Report]. 2002. November 29, 2012, CDC Web site: http:/ / www.cdc.gov/ mmwr/ preview/ mmwrhtml/ mm5149a1.htm Center for Disease Control and Prevention. (November 15, 2012). The CDC and Public Health Response to the 2012 Fungal Meningitis and Other Infections Outbreak [2012 Testimony for HELP]. Available November 21, 2012, from U.S. Senate Web site: http:/ / www.help.senate.gov/ imo/ media/ doc/ Bell.pdf Center for Medicaid and CHIP Services. (October 31, 2012). CMCS Informational Bulletin (Version Unknown) [Meningitis Outbreak: Interim Treatment Guidance]. Available November 9, 2012, from Department of Health & Human Services Web site: http:/ / www.medicaid.gov/ Federal-Policy-Guidance/ downloads/ CIB-10-31-12.pdf Food and Drug Administration. (November 15, 2012). Statement of Margaret A. Hamburg, M.D [Testimony before HELP]. Available November 21, 2012, from U.S. Senate Web site: http:/ / www.help.senate.gov/ imo/ media/ doc/ Hamburg3.pdf Mercy Mount. (n.d.). In unknown (Ed.), Mercy Mount Country Day School. Retrieved December 3, 2012, from Mercy Mount Web site: http:/ / www.mercymount.org/ Capital/ CapitalListofDonors.htm O 'Reilly, K. B. (2012, October 29). In AMA (Ed.), Meningitis outbreak tests physician trust in compounding pharmacies [Article]. Retrieved October 29, 2012, from AMA Web site: http:/ / www.ama-assn.org/ amednews/ 2012/ 10/ 29/ prl21029.htm Pegues, D. A. (2006). Improving and Enforcing Compounding Pharmacy Practices to Protect Patients. Oxford Journal, 43(7), 838-840. Retrieved November 21, 2012, from JSTOR: http:/ / www.jstor.org/ stable/ 4484978 Perfect, J. R., & Schell, W. A. (1996). The New Fungal Opportunists Are Coming. Clinical Infectious Disease, 22(2), S112-S118. Retrieved November 22, 2012, from JSTOR Web site: http:/ / www.jstor.org/ stable/ 4459452 Professional Risk Advisor. (n.d.). In Unknown (Ed.), Professional Risk Advisor. Retrieved December 3, 2012, from Professional Risk Advisor Web site: http:/ / www.professionalriskadvisor.com/ 0303-settlement.html Serrie, J.…
As a Chief Nursing Officer, I’m responsible for one of the state’s largest Obstetric Health Care Centers. I just received word of some fraudulent behaviors in the center. To mitigate this type of behaviors I must evaluate how the healthcare Qui Tam affects health care organizations, provide four examples of Qui Tam cases that exist in a variety of health care organizations, Devise a procedure for admission into a health care facility that upholds the law about the required number of Medicare and Medicaid referrals, Recommend a corporate integrity program that will mitigate incidents of fraud and assess how the recommendation will impact issues of reproduction and birth, and Devise a plan to protect patient information that complies with all necessary laws. After completing my evaluation on Qui Tam I will be able to provide a proper protocol to handle or prevent future issue and grow awareness on how fraudulent behavior affects the health care center.…
On May 14, 2013 Attorney General Eric Holder and Department of Health and Human Services (HHS) Secretary Kathleen Sibelius announced “nationwide takedown” by Medicare Fraud Strike Force operations, in eight cities that resulted in charges against 89 individuals, which included doctors, nurses and other licensed medical professionals, for their alleged participation in Medicare fraud schemes involving approximately $223 million in false billings. In Chicago, seven individuals were charged, including two doctors, with a variety of health care fraud schemes. This (sixth) nationwide takedown targeted eight cities: Miami, Houston, Los Angles, Detroit, Tampa, Brooklyn N.Y, and Chicago.…
Fraud, Abuse, and Waste in the US Healthcare System is a major problem. As a result of this the government is spending a greater percentage of the GDP on healthcare for Americans. The primary reason for this increase in the overall cost for healthcare is related to the increase in fraud, waste, and abuse. It is estimated that the United States spends between 15 and 25 billion dollars annually because of fraud, waste, and abuse. We will examine the [pic]types of fraud, waste, abuse, the[pic] involvement [pic]of the[pic] federal government in prevention, the roles of healthcare organizations and employees, and the protection for whistle-blowers and consequences for those involved in fraud, waste, and abuse.…
Anti-trust laws in the United States have been effectively used to prevent monopolies in industries like telecommunications, oil and gas and computer software. Anti-trust laws are enforced in order to maintain free competition in the marketplace, which generates lower prices and incentivizes the development of high quality products. Today, hospital systems are experiencing an era of heavy consolidation, which include mergers and acquisitions and physician practice buy-outs. According to the Wall Street Journal, hospitals completed 86 merger and acquisition deals valued at $7.9 billion in 2011, which was the most in a decade. Like in other industries, this developing trend in hospital consolidations encourages price fixing and contributes to rising healthcare costs and excessive medical billing. In order to manage healthcare costs in the United States and address unfair medical billing practices, anti-trust laws should be enforced within the healthcare industry.…
There are many way to spot a scam or fraud in the medical field. Medical frauds range from people posing as doctors and practicing without a license, to useless supplements, worthless or dangerous diet aides, fake medicines and cures for cancer. Making good health decisions is hard and sadly some immoral people make it even more difficult by attempting to deceive and cheat the sick. Not everyone knows enough about medicine to spot a medical fraud or scam but this essay will give you some places to start. Avoiding medical fraud is important because a delay in real treatment can create potentially deadly complications.…
Generally, the purpose of the ethics committee in health care is to deliberate and rectify complicated and unusual matters involving issues that affect the care, and treatment of patients within the health care institution (Morrison, 2014). Members of the ethics committee should be chosen on the elements of their concern for the welfare of the sick and interest matters, and their reputation in the community and among their peers for integrity and mature judgment. Ideally, the purpose of the ethics committee should be curbed solely to ethical matters. In addition, the ethical committee’s communications and deliberations should comply with institutional and ethical policies for protecting the privacy of patient’s information (Greenwood, 2015)…
It’s definitely true that if a person has the mindset to act fraudulently they definitely will do it by all means necessary. I like your suggestion about the laws and statues. However, this is where the compliance plan comes in. Compliance officers take courses in law and are actively working with these laws. Basically, this is what they live for. This is why it’s important to have a CCO in a healthcare facility because a regular health care professional will definitely be lost in the world of the laws.…
Fraud and abuse has a big part in our medical system. Every year more and more money goes into Medicare without regard to accountability. Michael Sparrow, a top specialist in health care fraud at Harvard university- says “that estimates by federal auditors do not measure all types of fraud. He believes that as much as 20 percent of federal health program budgets are consumed by fraud and abuse, which would be about $85 billion a year for Medicare”. Federal housing, student loans, and unemployment benefits are more hot spots for abuse and fraud. Americans need to step back and see what they’re doing to themselves and to each other. We as a people will only fully understand what’s happening once they understand the cause to these issues.…
Healthcare Fraud - is knowingly and willfully executes or attempts to execute a scheme to defraud any healthcare benefit program, or to obtain by false or fraudulent pretense. Therefore, in order to prove fraud the government must prove that the act performed was knowingly, willfully and intentionally.…
Health care fraud, specifically Medicare and Medicare fraud, is becoming big business. Medicare fraud is a general term that refers to an individual or corporation that seeks to collect Medicare health care reimbursement under false pretenses. There are many different types of Medicare fraud, all of which have the same goal: to collect money from the Medicare program illegitimately. Medicare fraud is generally easy to do because it was originally set up as an “honor system” of billing. The United States government wanted to help honest doctors who helped the needy with medical services. There are not a lot of safeguards or internal controls in place to detect false claims. Most claims are paid automatically because the goal of Medicare was to pay claims quickly. Organized crime and gangs are starting to specialize in this type of fraud as it is much easier than selling drugs and if they are eventually caught the punishments are treated more like white collar criminals than drug dealers.…
As your fourth assignment toward completion of the Session Long Project you are asked to review the paper by A. Mains, A. Coustasse, K. Lykens: Physician Incentives: Managed Care and Ethics and answer the questions below.…
Medical identity theft is when someone uses your personal identity to use your medical insurance benefits to get free medical services and/or make false claims to gain financial assistance by using your identity. Medical identity theft accounts for 3 percent of identity theft crimes, or 249,000 of the estimated 8.3 million people who have had their identities stolen in 2005, according to the Federal Trade Commission. It is estimated that people who are affected by this crime are left with $40,000 + in bills for services they never used. Medical identity theft can take place in private doctor’s offices, hospital’s, or pharmacy’s. A single person or a group could be involved in this crime. Some people fear that with the electronic medical records from paper that it may be easier to get peoples medical identity. Many people don’t even realize that they have been a victim of this crime until months to years down the road.…
Worker’s Compensation frauds committed by employers consist of the biggest percentage of all. According to Johnson, employers is the real problem behind the frauds as it is the most expensive for insurance companies. While some states like Florida, California, Texas and Ohio is fighting all types of Worker’s Compensation fraud, others do not. In the estimate provided by the Department of Labor, between 10 to 30 percent of employers misclassified some employess15. Since the premiums are extremely expensive for the employers, they often underreport the payrolls and misclassify their employees in order to reduce the premiums that they have to pay to get coverage. Underreporting and misclassification not only cheat the insurance companies which…