Terry L. Leap's Phantom Billing, Fake Prescriptions, and the High Cost of PDF

By Terry L. Leap

ISBN-10: 0801449790

ISBN-13: 9780801449796

U.S. health and wellbeing care is a $2.5 trillion approach that money owed for greater than 17 percentage of the nation's GDP. it's also hugely at risk of fraud. Estimates range, yet a few observers think that up to 10 percentage of all clinical billing includes a few kind of fraud. In 2009, New York's Medicaid fraud place of work recovered $283 million and bought 148 legal convictions. In July 2010, the U.S. Justice division charged approximately a hundred sufferers, medical professionals, and well-being care executives in 5 states of bilking the Medicare method out of greater than $251 million via fake claims for providers that have been medically pointless or by no means supplied. those instances purely trace on the scope of the problem.
In Phantom Billing, faux Prescriptions, and the excessive rate of drugs, Terry L. jump takes on clinical fraud and its monetary, mental, and social bills. Illustrated all through with dozens of particular and sometimes attention-grabbing situations, this publication covers a large choice of crimes: kickbacks, illicit referrals, overcharging and double billing, upcoding, unbundling, rent-a-patient and pill-mill schemes, assurance scams, short-pilling, off-label advertising of prescription drugs, and rebate fraud, in addition to legal acts that let this fraud (mail and cord fraud, conspiracy, and funds laundering).
After assessing the effectiveness of the federal legislation designed to struggle wellbeing and fitness care fraud and abuse—the antikickback statute, the Stark legislations, the fake Claims Act, HIPAA, and the nutrients and drug laws—Leap indicates a few ways in which overall healthiness care services, shoppers, insurers, and federal and kingdom officers can deliver healthiness care fraud and abuse below keep watch over, thereby decreasing the general expense of therapy in the US.

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Extra resources for Phantom Billing, Fake Prescriptions, and the High Cost of Medicine: Health Care Fraud and What to Do about It

Example text

Lee Pearce. The shareholder committee spent eight years publicizing fraud and abuse at Tenet before dissolving itself at the end of 2008. 52 Compensation practices can also encourage health care fraud and abuse. Many health care providers are paid by the number of patients they see or by the number of treatments or services they render, tempting them to overstate the amount of work they actually perform. And high-salaried health care executives may receive a significant portion of their compensation through stock options.

Getting cold feet and withdrawing from a conspiracy does not necessarily protect a party from criminal charges. Furthermore, prosecutors may grant leniency to those playing a less significant role in the conspiracy in exchange for information or testimony against the more culpable participants. Whether chains or wheels, conspiracy is an “inchoate” crime. That is, perpetrators of a health care fraud may be arrested for planning a crime even before they have the opportunity to execute it. Suppose that three former information technology employees at a medical center plan to steal patient medical information and use the information to commit identity theft.

Furthermore, prosecutors may grant leniency to those playing a less significant role in the conspiracy in exchange for information or testimony against the more culpable participants. Whether chains or wheels, conspiracy is an “inchoate” crime. That is, perpetrators of a health care fraud may be arrested for planning a crime even before they have the opportunity to execute it. Suppose that three former information technology employees at a medical center plan to steal patient medical information and use the information to commit identity theft.

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Phantom Billing, Fake Prescriptions, and the High Cost of Medicine: Health Care Fraud and What to Do about It by Terry L. Leap


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