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 The Battle Over Health Care written by Rosemary Gibson and published by Rowman & Littlefield Publishers. This book was released on 2012-04-08 with total page 233 pages. Available in PDF, EPUB and Kindle. Book excerpt: As the most substantial health care reform in almost half a century, President Obama's health care overhaul was as historic as it was divisive. In its aftermath, the debate continues. Drawing on decades of experience in health care policy, health care delivery reform, and economics, Rosemary Gibson and Janardan Prasad Singh provide a non-partisan analysis of the reform and what it means for America and its future. The authors shine a light on truths that have been hidden behind a raucous debate marred by political correctness on both sides of the aisle. They show how health care reform was enacted only with the consent of health insurance companies, drug firms, device manufacturers, hospitals, and other special interests that comprise the medical-industrial complex, which gained millions of new customers with the stroke of a pen. Health care businesses in a market-oriented system are designed to generate revenue, which runs counter to affordable health care. Gibson and Singh take a broader perspective on health care reform not as a single issue but as part of the economic life of the nation. The national debate unfolded while the banking and financial system teetered on the brink of collapse. The authors trace uncanny similarities between the health care industry and the unfettered banking and financial sector. They argue that a fast-changing global economy will have profound implications for the country's economic security and the jobs and health care benefits that come with it, and they predict that global competition will shape the future of employer-provided insurance more than the health care reform law.
Download or read book Fostering Innovation to Fight Waste Fraud and Abuse in Health Care written by United States. Congress. House. Committee on Energy and Commerce. Subcommittee on Health and published by . This book was released on 2013 with total page 102 pages. Available in PDF, EPUB and Kindle. Book excerpt:
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 Waste Fraud and Abuse in the Medicare Program written by United States. Congress. House. Committee on Commerce. Subcommittee on Health and the Environment and published by . This book was released on 1995 with total page 104 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book The Fraud and Abuse Provisions in H R 3600 the Health Security Act written by United States. Congress. House. Committee on Government Operations. Legislation and National Security Subcommittee and published by . This book was released on 1995 with total page 266 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Health Care Waste Fraud and Abuse written by United States. Congress. House. Committee on Ways and Means. Subcommittee on Health and published by . This book was released on 1998 with total page 140 pages. Available in PDF, EPUB and Kindle. Book excerpt:
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 Industry in Transition written by and published by Jones & Bartlett Learning. This book was released on 1999-06 with total page 578 pages. Available in PDF, EPUB and Kindle. Book excerpt: This publication covers the most current and significant trends affecting the health care industry today. In an extraordinary format of user-friendly CD-ROM and loose-leaf binder, Ernst & Young, LLP has compiled a treasury of data and analysis that will be useful to all health professionals and policy makers. The unique design of graphics and talking points makes the information ready-to-use for presentations.
Download or read book The Law of American Health Care written by Nicole Huberfeld and published by Aspen Publishing. This book was released on 2018-08-07 with total page 1112 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Law of American Health Care is the casebook for the new generation of health lawyers. It is a student-friendly casebook emphasizing lightly, carefully edited primary source excerpts, plain-language expository text, as well as focused questions for comprehension and problems for application of the concepts taught. The book engages topics in depth so students emerge with an understanding of the most important features of American health care law and hands-on experience working through cutting edge issues. Key Features: Focused on the needs of students who want to practice health care law in a post-ACA world. First health care law casebook to consider federal law as the baseline (as opposed to state law or common law). Intro chapter provides a set of organizing principles, illustrated with in-depth case studies, which are revisited and woven throughout the remaining chapters. “Pop-up” text boxes throughout with notes that highlight key lessons, or help to explain or enhance the material. Directed Questions and hypothetical Problems are provided as well as Capstone Problems at the end of each chapter. Approximately 800 pages, which is significantly more manageable than competitors. Focused directly on topics regularly encountered in the day-to-day practice of health law
Download or read book Inside National Health Reform written by John E. McDonough and published by Univ of California Press. This book was released on 2011-09-12 with total page 367 pages. Available in PDF, EPUB and Kindle. Book excerpt: This indispensable guide to the Affordable Care Act, our new national health care law, lends an insider’s deep understanding of policy to a lively and absorbing account of the extraordinary—and extraordinarily ambitious—legislative effort to reform the nation’s health care system. Dr. John E. McDonough, DPH, a health policy expert who served as an advisor to the late Senator Edward Kennedy, provides a vivid picture of the intense effort required to bring this legislation into law. McDonough clearly explains the ACA’s inner workings, revealing the rich landscape of the issues, policies, and controversies embedded in the law yet unknown to most Americans. In his account of these historic events, McDonough takes us through the process from the 2008 presidential campaign to the moment in 2010 when President Obama signed the bill into law. At a time when the nation is taking a second look at the ACA, Inside National Health Reform provides the essential information for Americans to make informed judgments about this landmark law.
Download or read book Congressional Record written by United States. Congress and published by . This book was released on 2004 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: The Congressional Record is the official record of the proceedings and debates of the United States Congress. It is published daily when Congress is in session. The Congressional Record began publication in 1873. Debates for sessions prior to 1873 are recorded in The Debates and Proceedings in the Congress of the United States (1789-1824), the Register of Debates in Congress (1824-1837), and the Congressional Globe (1833-1873)
Download or read book Medicare Reform written by United States. Congress. Senate. Committee on Finance and published by . This book was released on 2001 with total page 112 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book President s Proposal to Reform Medicare written by United States. Congress. Senate. Committee on Finance and published by . This book was released on 1999 with total page 152 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Prescription Drug Price Inflation written by United States. Congress. House. Committee on Energy and Commerce. Subcommittee on Health and published by . This book was released on 2012 with total page 256 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Reducing Overpayments and Increasing Quality in the Unemployment System written by United States. Congress. Senate. Committee on Finance and published by . This book was released on 2010 with total page 56 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Hearings Relating to Madison Guaranty S L and the Whitewater Development Corporation Washington DC Phase Treasury Department document production in response to S Res 229 written by United States. Congress. Senate. Committee on Banking, Housing, and Urban Affairs and published by . This book was released on 1994 with total page 1158 pages. Available in PDF, EPUB and Kindle. Book excerpt:
