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 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 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 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 A Health Care Quality Improvement System for Medicaid Managed Care written by and published by . This book was released on 1993 with total page 114 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Prescription for Profit written by Paul Jesilow and published by University of California Presson Demand. This book was released on 1993 with total page 247 pages. Available in PDF, EPUB and Kindle. Book excerpt: "A sound, well written, and highly interesting examination of how Medicaid . . . has given far too many physicians an opportunity to 'mop up' fraudulently, for their own financial gain, some of the $61 billion annual cost of the program."--Marshall B. Clinard, author of "The Abuse of Corporate Power" "A searching analysis of a problem that is of enormous concern to every nation. It is a lively, insightful treatment of the Medicaid malady, using the best diagnostics available to contemporary criminology."--John Braithwaite, Australian National University

Download or read book Title XX Social Services written by and published by . This book was released on 1980 with total page 40 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Medicaid Eligibility Quality Control written by United States. Social and Rehabilitation Service and published by . This book was released on 1975 with total page 460 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Fraud and abuse in the medicare and medicaid programs written by United States. Congress. House. Committee on Ways and Means. Subcommittee on Health and published by . This book was released on 1977 with total page 32 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Michigan Court Rules written by Kelly Stephen Searl and published by . This book was released on 1922 with total page 520 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Compilation of the Social Security Laws written by United States. Congress. House. Committee on Ways and Means and published by . This book was released on 1961 with total page 528 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Surveillance and Utilization Review in the Medicaid Program written by United States. Health Care Financing Administration and published by . This book was released on 1989 with total page 538 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book United States Attorneys Manual written by United States. Department of Justice and published by . This book was released on 1985 with total page 720 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Emerging Fraud written by Kiymet Tunca Caliyurt and published by Springer Science & Business Media. This book was released on 2012-03-31 with total page 200 pages. Available in PDF, EPUB and Kindle. Book excerpt: Fraud has become a challenging phenomena affecting economies worldwide. Anti-fraud measures are an integral part of today’s management practices and have found their way into business education. Yet in developing countries these topics have long been neglected and only limited research has been conducted in this area. This book fills an essential gap by analyzing the impact of fraud on developing economies, describing successful anti-fraud methods and featuring cases that exemplify the measures described. The book features contributions by outstanding experts in the field and is intended for academic readers with a special interest in fraud research.

Download or read book Improving the Quality of Care in Nursing Homes written by Institute of Medicine and published by National Academies Press. This book was released on 1986-02-01 with total page 432 pages. Available in PDF, EPUB and Kindle. Book excerpt: As more people live longer, the need for quality long-term care for the elderly will increase dramatically. This volume examines the current system of nursing home regulations, and proposes an overhaul to better provide for those confined to such facilities. It determines the need for regulations, and concludes that the present regulatory system is inadequate, stating that what is needed is not more regulation, but better regulation. This long-anticipated study provides a wealth of useful background information, in-depth study, and discussion for nursing home administrators, students, and teachers in the health care field; professionals involved in caring for the elderly; and geriatric specialists.

Download or read book Medicare and Medicaid Budget Reconciliation written by United States. Congress. House. Committee on Energy and Commerce. Subcommittee on Health and the Environment and published by . This book was released on 1994 with total page 580 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Financial Assistance by Geographic Area written by United States. Department of Health, Education, and Welfare. Office of the Deputy Assistant Secretary, Finance and published by . This book was released on with total page 504 pages. Available in PDF, EPUB and Kindle. Book excerpt: