Download or read book Health Care Fraud and Abuse written by Aspen Health Law Center and published by . This book was released on 1998 with total page 156 pages. Available in PDF, EPUB and Kindle. Book excerpt: 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.
Download or read book License To Steal written by Malcolm K Sparrow and published by Basic Books. This book was released on 2007-12-14 with total page 306 pages. Available in PDF, EPUB and Kindle. Book excerpt: 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.
Download or read book Healthcare Fraud written by Rebecca S. Busch and published by John Wiley & Sons. This book was released on 2012-05-01 with total page 374 pages. Available in PDF, EPUB and Kindle. Book excerpt: 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.
Download or read book Statistics and Health Care Fraud written by Tahir Ekin and published by CRC Press. This book was released on 2019-02-07 with total page 161 pages. Available in PDF, EPUB and Kindle. Book excerpt: Statistics and Health Care Fraud: How to Save Billions helps the public to become more informed citizens through discussions of real world health care examples and fraud assessment applications. The author presents statistical and analytical methods used in health care fraud audits without requiring any mathematical background. The public suffers from health care overpayments either directly as patients or indirectly as taxpayers, and fraud analytics provides ways to handle the large size and complexity of these claims. The book starts with a brief overview of global healthcare systems such as U.S. Medicare. This is followed by a discussion of medical overpayments and assessment initiatives using a variety of real world examples. The book covers subjects as: • Description and visualization of medical claims data • Prediction of fraudulent transactions • Detection of excessive billings • Revealing new fraud patterns • Challenges and opportunities with health care fraud analytics Dr. Tahir Ekin is the Brandon Dee Roberts Associate Professor of Quantitative Methods in McCoy College of Business, Texas State University. His previous work experience includes a working as a statistician on health care fraud detection. His scholarly work on health care fraud has been published in a variety of academic journals including International Statistical Review, The American Statistician, and Applied Stochastic Models in Business and Industry. He is a recipient of the Texas State University 2018 Presidential Distinction Award in Scholar Activities and the ASA/NISS y-Bis 2016 Best Paper Awards. He has developed and taught courses in the areas of business statistics, optimization, data mining and analytics. Dr. Ekin also serves as Vice President of the International Society for Business and Industrial Statistics.
Download or read book Healthcare Fraud Investigation Guidebook written by Charles E. Piper and published by CRC Press. This book was released on 2017-07-27 with total page 230 pages. Available in PDF, EPUB and Kindle. Book excerpt: Some have estimated that healthcare fraud in the United States results in losses of approximately $80 billion a year. Although there are many books available that describe how to "detect" healthcare fraud, few address what must be done after the fraud is detected. Filling this need, Charles Piper‘s Healthcare Fraud Investigation Guidebook details n
Download or read book Fraud and Abuse Investigations Handbook for the Health Care Industry written by Paul W. Shaw and published by . This book was released on 2021 with total page 775 pages. Available in PDF, EPUB and Kindle. Book excerpt: 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.
Download or read book Phantom Billing Fake Prescriptions and the High Cost of Medicine written by Terry L. Leap and published by Ilr Press. This book was released on 2011 with total page 237 pages. Available in PDF, EPUB and Kindle. Book excerpt: Confronting medical fraud and its economic, psychological, and social costs.
Download or read book Crossing the Global Quality Chasm written by National Academies of Sciences, Engineering, and Medicine and published by National Academies Press. This book was released on 2019-01-27 with total page 399 pages. Available in PDF, EPUB and Kindle. Book excerpt: In 2015, building on the advances of the Millennium Development Goals, the United Nations adopted Sustainable Development Goals that include an explicit commitment to achieve universal health coverage by 2030. However, enormous gaps remain between what is achievable in human health and where global health stands today, and progress has been both incomplete and unevenly distributed. In order to meet this goal, a deliberate and comprehensive effort is needed to improve the quality of health care services globally. Crossing the Global Quality Chasm: Improving Health Care Worldwide focuses on one particular shortfall in health care affecting global populations: defects in the quality of care. This study reviews the available evidence on the quality of care worldwide and makes recommendations to improve health care quality globally while expanding access to preventive and therapeutic services, with a focus in low-resource areas. Crossing the Global Quality Chasm emphasizes the organization and delivery of safe and effective care at the patient/provider interface. This study explores issues of access to services and commodities, effectiveness, safety, efficiency, and equity. Focusing on front line service delivery that can directly impact health outcomes for individuals and populations, this book will be an essential guide for key stakeholders, governments, donors, health systems, and others involved in health care.
Download or read book The Medicare Handbook written by and published by . This book was released on 1988 with total page 44 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Undercover written by John W. Schilling and published by AuthorHouse. This book was released on 2010-09 with total page 306 pages. Available in PDF, EPUB and Kindle. Book excerpt: When John Schilling, an unassuming midlevel accountant, joined Columbia Healthcare Corporation -- the nation's fastest growing and revolutionary network of public hospitals -- it seemed like the start of an exciting new career with great advancement and earnings potential. He never expected to become a catalyst for the series of "whistleblower" lawsuits that ripped through the healthcare industry in the late 1990s In Undercover, John Schilling tells the story of his harrowing journey from ordinary citizen and loyal employee to covert FBI informant and top witness for the Justice Department in the largest criminal healthcare fraud case in U.S. history. It began when he stumbled upon evidence-- a $3.5 million accounting "error"--of his company's routine practice of defrauding Medicare. When pressured to comply with stealing from taxpayers, Schilling knew he had to speak up for what he believed was right, regardless of the cost to his job, his reputation, and his family. His courageous choice would consume the next seven years of his life, leading to more drama, angst, turmoil, and money than he could have imagined. Ultimately, Schilling's moral conviction and a little known law, the False Claims Act, paid off by forcing the formidable healthcare conglomerate of Columbia/HCA to pay back $1.7 billion to the federal government. Revealing the personal side of a thankless role, Undercover is a gripping and inspiring account of a long, hard, life-- changing quest for justice. ADVANCE PRAISE FOR UNDERCOVER "Undercover crackles with authenticity as it recounts in a lively, readable style how a man on the inside risked everything and blew the whistle on a giant healthcare company that was systematically looting the Medicare program out of billions. A good read for anyone, but a must-read for someone who may contemplate taking the same path as John Schilling" -- John R. Phillips, "The nation's premier whistleblowing attorney" according to the The Wall Street Journal and the National Law Journal "John Schilling's book is a must-read for whistleblowers. He shows you how hard it can be, yet also shows you how to prevail. Best of all, John shows you how to be a good citizen" -- Jim Moorman, past President, Taxpayers Against Fraud
Download or read book Healthcare Fraud Corruption and Waste in Europe written by Misja Mikkers and published by . This book was released on 2017 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: 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... --
Download or read book Medicare Fraud written by United States. Congress. Senate. Special Committee on Aging and published by . This book was released on 1995 with total page 64 pages. Available in PDF, EPUB and Kindle. Book excerpt: Distributed to some depository libraries in microfiche.
Download or read book Health Care Fraud and Abuse written by Linda A. Baumann and published by Bureau of National Affairs (BNA). This book was released on 2013 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Medicare Fraud and Abuse written by United States. Congress. Senate. Special Committee on Aging and published by . This book was released on 1992 with total page 240 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Medicare Fraud and Abuse written by United States. Congress. Senate. Committee on Finance and published by . This book was released on 1997 with total page 112 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Medicare Fraud Prevention written by United States. Congress. Senate. Committee on Governmental Affairs. Permanent Subcommittee on Investigations and published by . This book was released on 1998 with total page 260 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Health Care Fraud and Abuse written by Hoyt W. Torras and published by American Medical Association Press. This book was released on 2003 with total page 452 pages. Available in PDF, EPUB and Kindle. Book excerpt: A guide for physicians covering the legal aspects of health insurance and offers ways to design an effective billing, coding, and accounts receivable process.
