Download Phantom Billing, Fake Prescriptions, and the High Cost of by Terry L. Leap PDF
By Terry L. Leap
U.S. wellbeing and fitness care is a $2.5 trillion process that bills for greater than 17 percentage of the nation's GDP. it's also hugely liable to fraud. Estimates range, yet a few observers think that up to 10 percentage of all scientific billing comprises a few kind of fraud. In 2009, New York's Medicaid fraud workplace recovered $283 million and bought 148 legal convictions. In July 2010, the U.S. Justice division charged approximately a hundred sufferers, medical professionals, and future health care executives in 5 states of bilking the Medicare process out of greater than $251 million via fake claims for companies that have been medically pointless or by no means supplied. those situations basically trace on the scope of the problem.
In Phantom Billing, faux Prescriptions, and the excessive expense of medication, Terry L. jump takes on clinical fraud and its monetary, mental, and social expenses. Illustrated all through with dozens of particular and infrequently interesting instances, this ebook covers a wide selection of crimes: kickbacks, illicit referrals, overcharging and double billing, upcoding, unbundling, rent-a-patient and pill-mill schemes, coverage scams, short-pilling, off-label advertising of prescription drugs, and rebate fraud, in addition to felony acts that let this fraud (mail and twine fraud, conspiracy, and cash laundering).
After assessing the effectiveness of the federal legislation designed to struggle future health care fraud and abuse—the antikickback statute, the Stark legislation, the fake Claims Act, HIPAA, and the nutrients and drug laws—Leap indicates a few ways in which future health care prone, shoppers, insurers, and federal and nation officers can deliver health and wellbeing care fraud and abuse lower than regulate, thereby lowering the final expense of treatment in the USA.
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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
Sample text
Thus, health care fraud is ever changing. Types of frauds committed twenty years ago may have fallen by the wayside only to be replaced by newer and more 20 INTRODUCTION innovative ones. Although criminals as a group score lower on intelligence tests than do law-abiding citizens, those committing health care fraud are often quite ingenious, especially when it comes to developing new fraud schemes. Victims of street crimes such as robbery or assault are immediately aware of their predicament. Victims of financial crimes such as identity theft or credit card fraud are usually aware within a few days of the transgressions against them.
Health care system. An understanding of health care fraud and abuse should begin with a discussion of health care law—a topic addressed in the following two chapters. But antifraud and abuse laws are of little value unless resources are provided to enforce them. So, as another presidential administration takes a stab at health care reform, such efforts—no matter how well intentioned—are doomed to failure unless we have both a plan and the resources to fight this monumental problem. 1 HEALTH CARE FRAUD AND ITS FACILITATING CRIMES The False Invoice Scheme Two business partners, one living in Texas and the other in Tennessee, had a good thing going.
40 The mail and wire fraud statutes make it a criminal act for anyone to use the mail service or the wires to advance a fraudulent scheme across state lines. S. Postal Service, but also to items shipped by package delivery services such as UPS and FedEx. Although the transmission of sales hyperbole does not constitute mail or wire fraud, true but misleading statements may violate federal law. An advertisement 34 CHAPTER 1 claiming that a certain vitamin will make a person “feel like a million dollars” is sales hyperbole.