Health Care Fraud Summary

We have recently learned the Department of Health and Human Services is investigating Houston Methodist for Medicare fraud. We will cooperate with and respect the officials conducting the investigation and are confident we will be exonerated of all allegations. We believe that we will be found innocent once the investigation is complete.

In the news recent was the Miami physician pleads guilty for role in $20 Million health care fraud scheme (Justice. Gov). The FBI and HHS-OIG investigated the case, which was brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office of the Southern District of Florida (Justice.

Medicaid fraud is illegal, but it is still big business. According to the Office Of Management and Budget, Medicare made nearly $47.8 billion improper payments in 2010. This is nearly 10 percent of the $528 billion spent on Medicare. The United States cannot afford to keep dealing with this type of fraud.

You’re sitting at home one afternoon, three weeks prior to the start of Open Enrollment, when you get a call from a friendly Center for Medicare Services (CMS) employee. The caller tells you that Medicare is issuing “new cards,” and that you need to provide your Medicare number, birth date and social security number in order to get yours. The catch? The caller doesn’t work for CMS, and he’s actually trying to steal your identity. Elder abuse is one of the most common crimes of the 21st century. In fact, studies have shown that 2 in 10 older adults have been financially exploited. Read on for 5 tips on avoiding common types of Medicare scams.

As anyone can see, health care fraud is a huge issue in the United States and with the upcoming nationalized health care system finally going into effect this year, more opportunities

According to Joe Conason, "America 's current health care system wastes considerably more than a trillion dollars every year. We know that because countries such as France, Germany, Japan and Finland, with comparable standards of living to ours, spend roughly half what the United States spends annually on health care per citizen, while covering everyone and achieving better results." (Conason, 2009) The United States healthcare financial systems are severely flawed - affecting the overall cost control, services, and care made accessible to its clients. The rising costs in healthcare are reaching new highs, and with rising costs, there doesn 't seem to be much change in the quality of the care being given. Clients coming in and out of these

Medicaid fraud is a concern in the medical world. The problem that medicaid faces is that people on that program are the most vulnerable of all. Many, do not understand what type of treatment they are getting, and don’t question whether they need the treatment or not. Furthermore, medicaid does not send the claims made by the provider to the client, or does not explain the services already paid. The case of “Davis Ethical Pharmacy,” proves the medicaid have a weak point: William Davis(the pharmacist involved in the medicaid fraud), took advantage of that weakness. He stole money from medicaid by “improperly billing,” not only he did it during store hours; but also after the drug store was supposed to be closed. As a patient, I would be concerned

At least 3% of that spending (68 billion) is lost to fraud each year. Raising health care costs for everyone.

Healthcare fraud and abuse in 2014 was costing Americans billions of dollars each year. Healthcare fraud intentions was to deceive a company into paying for services that in most case was not provided or should not been provided. Majority of the ones breaking the law are as follows physicians, patients,laboratories and some hospitals.

So, what is healthcare fraud and abuse is, you may ask? When talking about healthcare fraud and abuse, we are talking about 2 major statutes in the healthcare industry, Physician Self-Referral (Stark) Law and AKS (Anti-Kickback Statutes). These laws apply to many practices and procedures within organizations and can be manipulated to benefit an organization financially. The Physician Self-Referral Law prohibits entities from presenting a claim to anyone for healthcare services for a service not rendered and it also prohibits a physician for creating a referral for services that are designated but are not rendered. AKS prohibits anyone from offering a kickback, paying a kickback, or receiving a kickback in return for the delivery of health care services. However, the AKS encourages referrals based on monetary rewards to the primary source rather than

Although Congress has used several anti-fraud measures to protect the federal government health care programs, the False Claims Act of 1986 has become the main weapon that government prosecutors use against perpetrators of health care fraud. Designed to prevent fraud and other abuses in federal government programs, the False Claims Act has been the primary statute the government has used in its fight against health care fraud. However, government prosecutors do not rely on one statute in their prosecution of alleged cases of health care fraud. Instead, they rely on a combination of statutes, but the False Claims Act has emerged as the main statutory weapon.

What is healthcare fraud? Healthcare fraud is a criminal behavior, in which a person files a false claim, with the purpose of reimbursement. Healthcare abuse is similar, but focuses more on practices that do not match up with accepted solid financial, business, or medical practices, thus resulting in an avoidable cost or repayment for services that are not needed, or that fail to meet professionally familiar values for healthcare (Johns Hopkins, n.d.). While these both may have very different definitions, they are fall under the category of healthcare fraud and are both punishable by law when convicted. Healthcare fraud may be something as simple as a doctor over billing the insurance for only a few dollars, all the way on up to

The Healthcare System in the United States has several issues. The Movie, Escape Fire: The Fight to Rescue American Healthcare points out a few of the issues in its system. Some of those issues include over medicating patients, treating problems and not the whole person, reimbursement problems from the government, overtreatment, and how it is an entrenched system.

Collectively, the Department of Health and Human Services and the Department of Justice work to reduce healthcare fraud and investigate dishonest providers and suppliers. The Health Care Fraud Prevention and Enforcement Action Team recouped almost 3 billion in fraud, this year alone. Also, aggressive strategies exist to eliminate Medicare prescription fraud. Patients abusing or selling painkillers received by visiting several doctors and obtaining multiple prescriptions costs Medicare millions annually. Fraud affects everyone, preventing it requires government officials and citizens diligently working together.

The typically overlooked crime of healthcare fraud has resulted in a significant monetary loss on the part of the American public paying into government run medical programs, as well as private insurance company programs. Historically, we have seen that in any instance where money is involved people have found ways to or at least have attempted to obtain it illegally. Some do it through overt acts of violence such as a robbery. Others choose more covert ways of illegally obtaining money. This is usually conducted through fraudulent activities. This is the nature of white-collar crime. There is no force or violence involved but it is still illegal. (SSA) Obviously, when such a large amount of money is involved there is