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Author : Linda A. Baumann
Publisher : Bureau of National Affairs (BNA)
Page : 0 pages
File Size : 50,6 Mb
Release : 2013
Category : Health insurance
ISBN : 1617463019
Author : Hoyt W. Torras
Publisher : American Medical Association Press
Page : 452 pages
File Size : 41,7 Mb
Release : 2003
Category : Corruption
ISBN : UOM:39015056180469
A guide for physicians covering the legal aspects of health insurance and offers ways to design an effective billing, coding, and accounts receivable process.
Author : Terry L. Leap
Publisher : Cornell University Press
Page : 253 pages
File Size : 54,8 Mb
Release : 2011-04-15
Category : Medical
ISBN : 9780801461286
U.S. health care is a $2.5 trillion system that accounts for more than 17 percent of the nation’s GDP. It is also highly susceptible to fraud. Estimates vary, but some observers believe that as much as 10 percent of all medical billing involves some type of fraud. In 2009, New York’s Medicaid fraud office recovered $283 million and obtained 148 criminal convictions. In July 2010, the U.S. Justice Department charged nearly 100 patients, doctors, and health care executives in five states of bilking the Medicare system out of more than $251 million through false claims for services that were medically unnecessary or never provided. These cases only hint at the scope of the problem. In Phantom Billing, Fake Prescriptions, and the High Cost of Medicine, Terry L. Leap takes on medical fraud and its economic, psychological, and social costs. Illustrated throughout with dozens of specific and often fascinating cases, this book covers a wide variety of crimes: kickbacks, illicit referrals, overcharging and double billing, upcoding, unbundling, rent-a-patient and pill-mill schemes, insurance scams, short-pilling, off-label marketing of pharmaceuticals, and rebate fraud, as well as criminal acts that enable this fraud (mail and wire fraud, conspiracy, and money laundering). After assessing the effectiveness of the federal laws designed to fight health care fraud and abuse—the antikickback statute, the Stark Law, the False Claims Act, HIPAA, and the food and drug laws—Leap suggests a number of ways that health care providers, consumers, insurers, and federal and state officials can bring health care fraud and abuse under control, thereby reducing the overall cost of medical care in America.
Author : Aspen Health Law Center
Publisher : Unknown
Page : 156 pages
File Size : 47,8 Mb
Release : 1998
Category : Business & Economics
ISBN : PSU:000031855273
Stepped-up efforts to ferret out health care fraud have put every provider on the alert. The HHS, DOJ, state Medicaid Fraud Control Units, even the FBI is on the case -- and providers are in the hot seat! in this timely volume, you'll learn about the types of provider activities that fall under federal fraud and abuse prohibitions as defined in the Medicaid statute and Stark legislation. And you'll discover what goes into an effective corporate compliance program. With a growing number of restrictions, it's critical to know how you can and cannot conduct business and structure your relationships -- and what the consequences will be if you don't comply.
Author : Rebecca S. Busch
Publisher : John Wiley & Sons
Page : 374 pages
File Size : 45,5 Mb
Release : 2012-05-01
Category : Business & Economics
ISBN : 9781118179802
An invaluable tool equipping healthcare professionals, auditors, and investigators to detect every kind of healthcare fraud According to private and public estimates, billions of dollars are lost per hour to healthcare waste, fraud, and abuse. A must-have reference for auditors, fraud investigators, and healthcare managers, Healthcare Fraud, Second Edition provides tips and techniques to help you spot—and prevent—the "red flags" of fraudulent activity within your organization. Eminently readable, it is your "go-to" resource, equipping you with the necessary skills to look for and deal with potential fraudulent situations. Includes new chapters on primary healthcare, secondary healthcare, information/data management and privacy, damages/risk management, and transparency Offers comprehensive guidance on auditing and fraud detection for healthcare providers and company healthcare plans Examines the necessary background that internal auditors should have when auditing healthcare activities Managing the risks in healthcare fraud requires an understanding of how the healthcare system works and where the key risk areas are. With health records now all being converted to electronic form, the key risk areas and audit process are changing. Read Healthcare Fraud, Second Edition and get the valuable guidance you need to help combat this critical problem.
Author : David E. Matyas,Carrie Valiant
Publisher : Unknown
Page : 495 pages
File Size : 51,5 Mb
Release : 2006
Category : Health insurance
ISBN : 1422434362
Author : Kelly M. Pyrek
Publisher : CRC Press
Page : 326 pages
File Size : 47,6 Mb
Release : 2011-01-19
Category : Law
ISBN : 9781439820346
Crime perpetrated by healthcare professionals is increasingly pervasive in today‘s hospitals and other healthcare settings. Patients, coworkers, and employers are vulnerable to exploitation, fraud, abuse, and even murder. Investigative journalist Kelly M. Pyrek interviews experts who provide accounts concerning the range of criminality lurking in t
Author : Anonim
Publisher : Unknown
Page : 134 pages
File Size : 45,8 Mb
Release : 1998
Category : Health insurance
ISBN : 0834211238
Author : Paul W. Shaw,Robert A. Griffith
Publisher : Unknown
Page : 775 pages
File Size : 44,6 Mb
Release : 2021
Category : Fraud investigation
ISBN : 1663315000
The authors examine each stage of a fraud and abuse investigation, beginning with an overview of federal and state enforcement agencies, and concluding with a discussion of the potential collateral consequences of an investigation. They have supplemented their analysis extensively with sample documents, including indictments, requests for records, subpoenas, internal response memoranda, and responses to auditors, prosecutors, and more. Taken together, the materials in this book provide a true Handbook for anyone who needs to quickly and thoroughly understand the complex nature of a government fraud and abuse investigation.-Preface.
Author : Malcolm K Sparrow
Publisher : Hachette UK
Page : 304 pages
File Size : 55,7 Mb
Release : 2007-12-14
Category : Political Science
ISBN : 9780465010745
Who steals? An extraordinary range of folk -- from low-life hoods who sign on as Medicare or Medicaid providers equipped with nothing more than beepers and mailboxes, to drug trafficking organizations, organized crime syndicates, and even major hospital chains. In License to Steal, Malcolm K. Sparrow shows how the industry's defenses, which focus mostly on finding and correcting billing errors, are no match for such well orchestrated attacks. The maxim for thieves simply becomes "bill your lies correctly." Provided they do that, fraud perpetrators with any degree of sophistication can steal millions of dollars with impunity, testing payment systems carefully, and then spreading fraudulent billings widely enough across patient and provider accounts to escape detection. The kinds of highly automated, quality controlled claims processing systems that pervade the industry present fraud perpetrators with their favorite kind of target: rich, fast paying, transparent, utterly predictable check printing systems, with little threat of human intervention, and with the U.S. Treasury on the end of the electronic line. Sparrow picks apart the industry's response to the government's efforts to control this problem. The provider associations (well heeled and politically influential) have vociferously opposed almost every recent enforcement initiative, creating the unfortunate public impression that the entire health care industry is against effective fraud control. A significant segment of the industry, it seems, regards fraud and abuse not as a problem, but as a lucrative enterprise worth defending. Meanwhile, it remains a perfectly commonplace experience for patients or their relatives to examine a medical bill and discover that half of it never happened, or that; likewise, if patients then complain, they discover that no one seems to care, or that no one has the resources to do anything about it. Sparrow's research suggests that the growth of capitated managed care systems does not solve the problem, as many in the industry had assumed, but merely changes its form. The managed care environment produces scams involving underutilization, and the withholding of medical care schemes that are harder to uncover and investigate, and much more dangerous to human health. Having worked extensively with federal and state officials since the appearance of his first book on this subject, Sparrow is in a unique position to evaluate recent law enforcement initiatives. He admits the "war on fraud" is at least now engaged, but it is far from won.
Author : Brian K. Payne
Publisher : Charles C Thomas Publisher
Page : 192 pages
File Size : 53,6 Mb
Release : 2003-01-01
Category : Home care services
ISBN : 9780398083540
Over the past couple of decades, individuals have come to rely more on home health care visits for their health care needs. While there have been decreases in hospital stays and in the percentage of older persons living in nursing homes the consequence has been the emergence of a new type of occupational crime: home health care abuse. In considering offending in the home health care industry, it is important to focus on crimes by and against home health care professionals. This book is one of the first to fully address abuses occurring in the home health care industry. Its intent is not to suggest that home health care is a dangerous field for workers and consumers; rather, the intent is to shed some light on the types of misconduct found in home health care. Each chapter will include a wealth of examples to illustrate that these incidents actually are real, devastating, and significant. At the end of each chapter the reader will find a series of discussion questions designed to encourage the reader to reflect back on the content of the chapter through the eyes of those involved in the response to home health care fraud. Also included are Web site addresses where readers can learn more about the offenses and other resources to help demonstrate ways to deal with the problem. It is intended for criminal justice officials, health care professionals, academics, and researchers who want to better understand the nature of offending in the home health care industry. It is also intended for use in criminal justice, sociology, and white-collar crime courses exploring crime in the workplace as well as courses examining the home health care field. Chapters include: Home, Home on the Range: Where Health Care is Provided and Crimes are Committed; Home Health Care Professionals as Victims and Witnesses; Crimes by Home Health Professionals: Violence, Theft, and Deception; Responding to Crime in the Home Health Care Field: Strategies, Obstacles, and Issues; and Preventing Home Health Care Misconduct.
Author : BNA Books
Publisher : Unknown
Page : 376 pages
File Size : 55,8 Mb
Release : 2003
Category : Electronic
ISBN : 1570183759
Author : Misja Mikkers,Wolf Sauter,Paul Vincke,Jos Boertjens
Publisher : Unknown
Page : 0 pages
File Size : 41,7 Mb
Release : 2017
Category : Europe
ISBN : 9462366853
The lack of well-documented, factual information on fraud, waste and corruption in the healthcare sector is an important ally for those who would seek to abuse healthcare systems for their own profit. Our lack of knowledge of the incidence, nature and extent of fraud, waste and corruption in healthcare is a threat to the establishment of effective counter-fraud strategies. It prevents those who finance healthcare provision from understanding in clear and quantifiable terms the need to invest resources into counter-fraud activities. As a consequence, fraud remains a matter of moral hazard and healthcare systems continue to suffer considerable financial damage, as well as all the associated consequences for the quality of care that patients receive. It was for these reasons that the 'European Healthcare Fraud and Corruption Network' (EHFCN) and the 'Dutch Healthcare Authority' (NZa, member of EHFCN) decided to collaborate to publish this book... --
Author : OECD
Publisher : OECD Publishing
Page : 304 pages
File Size : 55,9 Mb
Release : 2017-01-10
Category : Electronic
ISBN : 9789264266414
Countries could potentially spend significantly less on health care with no impact on health system performance, or on health outcomes. This report reviews strategies put in place by countries to limit ineffective spending and waste.
Author : United States. General Accounting Office
Publisher : Unknown
Page : 40 pages
File Size : 51,7 Mb
Release : 1992
Category : Health Insurance
ISBN : UOM:39015050027401