The Criminal Case Of Dr. Richard Heartman, An Internal Medicine Physician

Ladies and gentlemen of the jury. Today we have a very serious charge before you. We have Dr Richard Kimball, who is before you on the charges of first-degree murder. However, he is not guilty based on our success to provide reasonable doubt that Kimball planned and deliberately kill his wife or that he was provoked into killing his wife in the heat of passion.

Husband and wife, Gary and Renna Pehle were infected with HIV at the time they applied for life insurance with Farm Bureau Life Insurance Company. The couple did not know they were infected with HIV at the time. The insurance company ran blood tests from the Pehles. The Pehles then signed a contract form which was given to them by a Farm Bureau agent. A nurse from Farm Bureau watched as the Pehles signed the contract. Blood samples were sent to a third-party laboratory called LabOne. Farm Bureau then sent a notice to the Pehles rejecting them from their life insurance policy, which advised the couple that if they wished to have their application reviewed to contact their physician. The Pehles did not take any action in doing so. Two years past and Renna Pehle is confirmed to have AIDS. The Pehles then sues Farm Bureau, LabOne, and LabOne’s medical director Dr. J. Alexander Lowden for negligence, for failing to tell them they were HIV-positive.

1. Was McClatchey a part of the conspiracy that was a direct violation of the Medicare Anti-Kickback law?

2) Frank A. Tassone; the former business manager, Pamela Gluckin; and an accounting clerk, Debra Rigano, who is a niece of Ms. Gluckin embezzled money in a scheme in which Dr. Tassone and Ms. Gluckin and nine of their family members and friends charged $5.9 million for personal items and cash advances on 74 personal credit cards. Then Ms. Gluckin and Dr. Tassone used district checks to pay those bills. The audit found that Dr. Tassone and

fraud, and then one count of aggravated identity theft related to a healthcare fraud (Morse,

The Unite States Sentencing Guidelines is the governing law when it comes to the sentencing of those who have violated federal criminal law. Specifically, under Part B: Chapter 1, which includes “Offenses Involving Fraud and Deceit.” Under this specific provision, it provides that every single instance of mailing or wiring fraud constitutes a separate count for sentencing purpose, and as the monetary loss of each victim increases or the intended loss, the punishment becomes gradually more

Mr. Pinkman has been charged with criminal violations of the FDCA, specifically 21 USC Sections 331(a), 333(a), 353(b)(1) and 352(f)(2). These are detailed below:

Some federal statutes address fraud in government health care programs, and many of these laws vary considerably (Krause 2004). Some of these laws specifically target health care fraud. Example of the laws that the government direct at inappropriate health care activities includes the “Medicare and Medicaid Anti-Kickback Statute and Ethics in Patient Referrals Act (EPRA).”

According to the Federal Bureau of Investigation (FBI) “health care fraud costs the country an estimated $80 billion dollars a year” ("Health Care Fraud," n.d., p. 1). Because health care costs continue to rise more rapidly than the rate of inflation the threat of health care fraud continues to rise. The Affordable Health Care Act has put new policies in place to identify and stop health care fraud. The FBI along with other government, insurance, and public agencies have joined together to combat fraud at every level. New rules in identifying, investigating, and prosecuting fraud before payments are made to medical providers could save billions of

The federal mail and wire fraud statutes ban plans or schemes to defraud that includes the utilization of mail or wire communications. Both condemn deceitful conduct that may likewise come surprisingly close to other federal criminal statutes. Both may serve as money laundering offenses. Both are deserving of imprisonment for not more than 20 years; for not more than 30 years, if the victim is a financial institution or the offense is committed in times of crisis. Victims in both of these situations are entitled to restitution. Both may bring about the relinquishment of property. The mail fraud statue was introduced in the early nineteenth century and the wire fraud statute is a little more recent as it was enacted in 1952.

Healthcare services have been on the rise for over 10 years now. According to a 2012 consumer alert, the industry provided $2.26 trillion in payments for more than four billion health insurance benefit claims in the year 2011(Fraud in Health Care). The bulk of the claims and the mainstream of fraud and abuse stem from the Medicare system professionals, who are knowledgeable about the process and persuade new clients into handing over their pertinent information in hopes of deception and illegitimate claims. Multiple and double billing, fraudulent prescriptions, are some of the major flaws in this organization that has made the healthcare services industry curdle. (AGHAEGBUNA, 2011) This is a non-violet crime and is often committed by very

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.

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.

As the healthcare industry begins to expand its horizons, by featuring more staff and patients, the types of frauds that are committed also rise in number and complexity. One of the many consequences that derives from fraud within the healthcare system includes an increase in the cost of healthcare itself. In order to limit and analyze fraud that encompasses the entirety of the healthcare industry, it is necessary to assess the different types of frauds and in doing so also understand the method of reimbursement involving the professionals and members of the health care industry. Since a majority of these reimbursements are paid by insurances or through government programs, a program known as coding was created in order to organize and properly pay off these reimbursements(Marilyn Price, Donna Norris, 2009). One of the many

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