Assignment and Case Mix Case #1 Female 66yo 01-Home ICD-9-CM Code Code Description Principal Diagnosis 682.7 Cellulitis‚ left foot Secondary Diagnosis 892.1 Infected dog bite 041.10 Staph infection E906.0 External cause: dog bite Principal Procedure 86.22 Wound debridement‚ foot Total Charges $6‚245.10 DRG: 0572‚ SKIN DEBRIDEMENT W/O CC/MCC DRG Wt. 01.0077____ Full Update Hospital Reimbursement___$5‚064.79__________ Reduced Update Hospital Reimbursement__$4‚762.49___________ Medicare Assigned DRG
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As a follow up to my questions last week on Halyard $HYH I did some more digging on the fraud case and thought I would pass along what I found out. Pete said that Mike did more work on this so it may be repetitive but here goes. I talked to Michael Avenatti the lawyer on the class case. He said the case is ongoing and should go to trial in the next few months. He said it is a Qui Tam case to recover money for the whistle blowers. He is not sure HYH will survive this as they have no insurance
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Association of Certified Fraud Examiners; conducts comprehensive fraud studies; Report to the Nation on Occupational Fraud & Abuse * Fraud - deception that includes: a representation‚ about a material point‚ which is false‚ and intentionally or recklessly so‚ which is believed‚ and acted upon by the victim to the victim’s damage. Fraud is an act of dishonesty with the intention to deceive or cover the truth to gain an advantage. Most critical element: confidence. Fraud can be classified as (in
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Case Study Tesco Horsemeat Scandal This case study analyses the horsemeat scandal‚ which involved several companies‚ included Tesco. Tesco is the UK ’s largest retailer and one of the world ’s leading international retailers. Tesco has more than 6‚000 stores worldwide‚ employing almost 520‚000 people (Tesco PLC‚ 2013a). Tesco operates in 12 different countries across Asia and Europe. Food and beverage retail is the main Tesco’s business but electronic device and clothing retail as Tesco bank and
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Railroad was authorized to construct a transcontinental railroad with substantial financial support from the federal government‚ officers and directors of the company devised a plan to make an immediate profit from its construction by fraud. The vehicle for this fraud was a company called Credit Mobilier of America. The method was to have Credit Mobilier‚ which was entirely controlled by the same people‚ bill the Union Pacific for the costs of constructing the railroad. There was no "market value"
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| | |Financial Statement Fraud | |Navistar International Corporation | |
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Introduction 3 II. About Medicare 4 III. About Medicaid 5 III. Fraud & Abuse of Medicare 7 IV. Fraud & Abuse of Medicaid 8 V. Prevention Program Methods/Reform for Medicare & Medicaid 9 VI. Conclusion 12 References 13 Executive Summary With the ever-changing difficulties of our health insurance landscape‚ the government has taken a more active role in the health care and well-being of American citizens. With this shift‚ programs like Medicare and Medicaid‚ become polarizing
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Payroll Patty Scam The Payroll Patty Scam is a payroll scam were a company nearly lost three quarters of a million dollars. The payroll clerk‚ known at Payroll Patty‚ was creating “ghost” employees in order to hide the fraud she was committing. The payroll clerk was adding these “ghost” employees to a separate cost center which was not noticed since the company typically had seasonal contract labor employees anyways. No red flags were noticed for a long time because it was typical for the company
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Fraud Examination & Forensic Accounting Professor: David L. Cotton Meriann El Haddad Student Travel Agent Fraud Analysis Christopher Ryan Thomas‚ who ran a travel business‚ was sentenced for stealing students’ spring break funds. In September 2006‚ Thomas was selected as a travel agent by the senior class at Hampton University who were planning a spring break trip to the Sunset Beach Resort and Spa in Jamaica. From November 2006 through April 2007‚ Thomas collected approximately
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KPMG United States- Oct. 17‚ 2015 1. Issuer O: “The Firm identified a fraud risk related to revenue. The Firm’s testing of controls over revenue and accounts receivable‚ however‚ was insufficient. Specifically: With respect to one of the issuer’s segments‚ which consisted of three business units‚ the Firm failed to identify and test any controls over revenue and accounts receivable for two of the business units‚ which‚ in combination‚ represented a significant portion of the issuer’s total revenue
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