Annotated Bibliography: Medicare Fraud And Abuse Issues
Annotated Bibliography: Medicare Fraud and Abuse
Carolann Stanek
University of Mary
Annotated Bibliography:
DiSantostefano, J. (2013). Medicare Fraud and Abuse Issues. Journal for Nurse Practitioners, 9(1), 61-63. doi:10.1016/j.nurpra.2012.11.014 The author reviewed Medicare fraud and abuse, provided a simplified overview of common fraud and abuse issues, and listed helpful examples of each. Establishing these concepts is integral to the avoidance of corruptive activities in healthcare practices.
Furrow, B.R., Greaney, T.L., Johnson, S.H., Stoltzfus Jost, T., and Schwartz, R.L. (2015). Health Law (3rd ed.) St. Paul, MN: West Academic. ISBN: 978-0-314-28907-0
This text examined in-depth false claims and statements, bribes,
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Roy is an example of physician liability in a Medicare fraud and abuse case. Because landmark penalties were enacted in regard to home health care fraud, this case is illustrative of the magnitude of Medicare infringement.
Government Publishing Office. (2017). United States of America vs. Johnny Trotter, II, M.D. and Elaine Lovett. Retrieved from https://www.gpo.gov/fdsys/pkg/USCOURTS-mied-2_14-cr-20273/pdf/USCOURTS-mied-2_14-cr-20273-6.pdf United States vs. Trotter and Lovett demonstrated how liability extends beyond a provider when Lovett, the owner of the billing company, was convicted of Medicare fraud and abuse. This case exemplifies how all workers within a healthcare system can be liable for the misuse of Medicare funds. Because of this, understanding the laws and regulations by healthcare workers is critical to ensure they are properly enforced.
Government Publishing Office. (2018). United States of America vs. Tracy Richardson Brown and Sandra Parkman Thompson. Retrieved from
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There have been several Acts and programs initiated to reduce the fraud and abuse of Medicare, all of which are crucial efforts that aim to reduce misuse and positively contribute to the financial state of healthcare in the United States.
Robertson, B. (2011). Reporting and Returning Medicare and Medicaid Overpayments. Journal of Health Care Compliance, 13(5), 51-66. This report recommended actions an individual can take if they made a mistake in the claims process that results in an overpayment by Medicare. Because the claim filing and payment processes are both a human-involved processes, occasional mistakes are inevitable. However, the steps taken once those mistakes are identified are integral to avoiding penalties and violations of Medicare fraud and abuse.
Santo, C. (2014). Walking a Tightrope: Regulating Medicare Fraud and Abuse and the Transition to Value-Based Payment. Case Western Reserve Law Review, 64(4),
Medpac Summary And Analysis
360 Words | 2 PagesShi and Singh (2015) states that the MedPac was established by the Balanced Budget Act of 1977 as an independent federal agency to advise the US congress on different issues that affect the Medicare program. MedPac regulations consist of analyzing payments to private health care providers that participates in Medicare, access to care, and quality of care (p. 214). Article written by Jill Wechsler (20090 states that MedPac concluded that Medicare payment system should reward value instead of volume to help encourage coordination of care with the different providers as well as constrain cost growth. They proposed alternatives that could help improve physician’s practices by support for graduate medical education, improve chronic care and
CMS Regulations And Reimbursement Models Paper
746 Words | 3 PagesImpact of CMS Regulations and Reimbursement Models The Health Care Industry HCM307-1802B-03 Unit 1- Individual Project 1 Michael Green May 22, 2018 Introduction Healing Hands Hospital is preparing financially for the many different reimbursement changes associated with Medicare Advantage Plans. My financial team and I, have been asked to evaluate our current billing and operations workflow processes and incorporate the current trends. We will be discussing how Medicare Advantage affects Healing Hands Hospital, and how we can utilize these trends to maximize patient care. Organizational Budget Reimbursement and financial trends will change go hand and hand.
Federal Anti-Kickback Statute Essay
491 Words | 2 PagesThe Federal Anti-Kickback Statute The Federal Anti-Kickback Statute is a criminal law that prohibits the knowing and willful payment of direct or indirect “remuneration”, to induce or reward patient referrals or the generation of business that involves any service or items payable by the Federal health care programs (e.g., drugs, supplies, or health care services for Medicare or Medicaid patients).[1] Remuneration can incorporate anything of value and can be of any form other than cash, for example travel tours, expenses for lavish hotel stays or immoderate compensation for medical consultations or referrals. In some industries, it is allowed to give compensation or reward to those who refer business. But, in the health care, referral is a
Icd-9 In The Health Care Industry
424 Words | 2 PagesFraud is all around us. Especially in the health care industry. What is being done to prevent fraud from reoccurring over and over in the health care industry? In the article “New medical codes can better catch fraud, but training is needed” by Tami Rockholt, RN, BSN; Mike Fossey; Mary McLean, BS discuses the topic of health care organizations transferring from ICD-9 to ICD-10 to help decrease fraud in the coding and billing department.
How HIPAA And Health Information Technology Impacts Health Finance
1161 Words | 5 PagesThe focus of this paper will be geared toward the impact that the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and Health Information Technology have on the cost of health care. The regulations connected to HIPAA have an impact on cost through enforcement, noncompliance, and implementation. HIPAA is a vital tool in the protection of PHI of patients and the improvement of the Medicare and Medicaid programs (Cleverly). Trying to contribute to the improvement of Medicare alone can be a daunting and expensive task alone, but to add the addition of protecting the health records of millions of patients adds to the rising cost. Health Information Technology (HIT), aids in the enforcement of HIPAA and helps with billing patients accurately for services that they have received (Wizemann).
Montana Code 50-602
753 Words | 4 PagesIn this case, criminal charges are established between healthcare organizations and the government. The punishment may involve a fine and/or imprisonment (McWay, 2014, pp.
Healthcare Reform 101 Summary
588 Words | 3 Pages“Healthcare Reform 101,” written by Rick Panning (2014), is a wonderful article that describes, in an easy-to-understand language, the Patient Protection and Affordable Care Act, signed into law March 23, 2010. The main goal of the Patient Protection and Affordable Care Act was to provide affordable, quality healthcare to Americans while simultaneously reducing some of the country’s economic problems. Two areas will be covered throughout this paper. The first section will include a summary of the major points and highlights of Panning’s (2014) article, including an introduction to the ACA, goals of the signed legislation, provided coverage, and downfalls of the current healthcare system. The second part will be comprised of a professional
Centers For Medicare Compliance Report
380 Words | 2 PagesIn 2001 Centers for Medicare & Medicaid was created and replaced the Health Care Financing Administration. The Centers for Medicare & Medicaid manages various programs. They include Medicare, Medicare Part D, Medicaid, Children Health Insurance, and Medicare Advantage. They also authorize different tasks within HIPAA that concern over a million healthcare providers and suppliers. The CMS influence healthcare quality measure which the President, Department of Health and Human Services, and the Centers for Medicare & Medicaid Services have ranked this as a high priority.
Argumentative Essay: Should Carla Tell?
398 Words | 2 PagesLying and cheating are dishonest behavior that can get you in trouble. In health care the state has set up a law on personal gain. You cannot ask for, or accept monetary gain over a certain amount to improve your business. It is called the anti-kickback statute (AKS). (hhs.gov pg,4) “The AKS is a criminal law that prohibits the knowing and willful payment of “remuneration” to induce or reward patient referrals or the generation of business involving any item or service payable by the Federal health care programs (e.g., drugs, supplies, or health care services for Medicare or Medicaid patients.”
Comparing Medicare And Long-Term Care
553 Words | 3 PagesRetrieved from https://search.proquest.com/docview/204518361?accountid=41759 CONCLUSION Our main focus should be to advocate for the coverage that would particularly benefit the patient rather than the particular model of funding. The essential features are universal health care (everyone must be covered), continuous health care coverage, affordability of insurance, economic sustainability for society, and provision of high-quality, timely, and equitable care that promotes patients' well-being. Practical geriatrics: Medicare managed mental health care: A looming crisis.
Ethical Issues In Managed Care
421 Words | 2 PagesMost physicians in the surveys believed that managed care prevent them from using their ability to put the patient's interest first and to avoid conflicts of interest with their patients. According to the survey, "forty-nine indicated negative effects when respecting their patients' autonomy. These finding, along with the concerned expressed above, that under managed care cost cutting took top priority over the quality of patient care and as a result trouble conflicted in the interest for physicians and patient care (Feldman, Novack, & Gracely,
Medicare Fraud Research Paper
301 Words | 2 PagesThese changes allow healthcare professionals to reap huge financial benefits for reporting Medicare fraud that is done by the healthcare industry. In some cases, people have been rewarded millions for reporting Medicare Fraud. People who report Medicare fraud are now able to receive up to 30 percent of the fines that are collected by the government. They are also able to receive full protection from retaliation. Hundreds of millions of dollars have been paid out by the United States government to people who have reported information about Medicare fraud.
Medicare Corrupts Government Spending
672 Words | 3 PagesHere is a short clip of an article from the Washington Post which exposes how medicare is corrupt and is an easy target for fraud. …in a Los Angeles courtroom, Bonilla described the workings of a peculiar fraud scheme that — starting in the mid-1990s — became one of the great success stories in American crime. The
Medicaid Reforms
1437 Words | 6 PagesFlexible funding also aided in providing services for all of the unexpected services listed above, that were needed to adequately care for the Medicaid recipients (Sandberg et al., 2014). Without the flexibility to reimburse the additional professionals for their services, the patients would have received disjointed care that did not meet their total needs and would have negatively impacted their overall
HIPAA Essay
503 Words | 3 PagesISSUE The Health Insurance Portability and Accountability Act (HIPAA) has continued to evolve. The latest rules concerning the patients rights to control protected health information (PHI) is problematic for the health system, may place the organization at risk, and compromise patient care. BACKGROUND
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