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Medicare Waste Fraud And Abuse
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Book Synopsis Health Care Fraud and Abuse by : Aspen Health Law Center
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.
Book Synopsis Fraud and Abuse Investigations Handbook for the Health Care Industry by : Paul W. Shaw
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.
Book Synopsis License To Steal by : Malcolm K Sparrow
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.
Book Synopsis Medicare Meltdown by : Rosemary Gibson
Download or read book Medicare Meltdown written by Rosemary Gibson and published by Rowman & Littlefield Publishers. This book was released on 2013-04-16 with total page 225 pages. Available in PDF, EPUB and Kindle. Book excerpt: Medicare affects everyone. If you are a boomer, you are counting on Medicare to protect you from the cost of health care when you retire. If you have turned 65, you already depend on Medicare. If you are a Gen-X or Gen-Y, you are contributing to Medicare from your paycheck. Will Medicare continue to exist as we have known it? Will it be there when you need it? How much will it cost? As the future of Medicare is debated in Washington, Rosemary Gibson and Janardan Prasad Singh shine a light on a rarely-seen side of this storied program: the business of Medicare. Medicare is known as an entitlement for the nation’s seniors. It is also the largest entitlement-based program for any business sector in the US economy. Its beneficiaries include hospitals, doctors, drug companies, device manufacturers, Wall Street investment banks, private equity firms, hedge funds, and others that rely on the $600 billion that Medicare spends a year. The ties that bind Wall Street and Washington in the healthcare industry are strong, and they will play an outsized role in determining Medicare’s future. Gibson and Singh reveal how the industry’s interests are often at odds with those of seniors and boomers. While some politicians point to the culture of dependence of the public on Medicare, the authors suggest that policymakers turn their attention to the culture of dependence of the healthcare industry on Medicare, which is the predominant force pushing the program toward a fiscal cliff. The amount of waste in the Medicare program is equivalent to the entire economy of New Zealand. For Medicare to be sustained, this culture of dependence -- and the habits it breeds, namely waste, excessive pricing, and overuse of unnecessary services -- should be the first priority for the chopping block. By parings back the excess, the authors argue, Medicare can be sustained for future generations. This is essential reading for anyone interested in how Medicare works, how it could work better, and where it will go if reforms are not made.
Book Synopsis A Health Care Quality Improvement System for Medicaid Managed Care by :
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:
Book Synopsis The Economics of US Health Care Policy by : Charles E. Phelps
Download or read book The Economics of US Health Care Policy written by Charles E. Phelps and published by Routledge. This book was released on 2017-11-13 with total page 420 pages. Available in PDF, EPUB and Kindle. Book excerpt: In this book, Phelps and Parente explore the US health care system and set out the case for its reform. They trace the foundations of today’s system, and show how distortions in the incentives facing participants in the health care market could be corrected in order to achieve lower costs, a higher quality of care, a higher level of patient safety, and a more efficient allocation of health care resources. Phelps and Parente propose novel yet economically robust changes to US tax law affecting health insurance coverage and related issues. They also discuss a series of specific improvements to Medicare and Medicaid, and assess potential innovations that affect all of health care, including chronic disease management, fraud and abuse detection, information technology, and other key issues. The Economics of US Health Care Policy will be illuminating reading for anyone with an interest in health policy, and will be a valuable supplementary text for courses in health economics and health policy, including for students without advanced training in economics.
Book Synopsis Section 1557 of the Affordable Care Act by : American Dental Association
Download or read book Section 1557 of the Affordable Care Act written by American Dental Association and published by American Dental Association. This book was released on 2017-05-24 with total page 60 pages. Available in PDF, EPUB and Kindle. Book excerpt: Section 1557 is the nondiscrimination provision of the Affordable Care Act (ACA). This brief guide explains Section 1557 in more detail and what your practice needs to do to meet the requirements of this federal law. Includes sample notices of nondiscrimination, as well as taglines translated for the top 15 languages by state.
Author :United States. Congress. House. Committee on Ways and Means. Subcommittee on Health Publisher : ISBN 13 : Total Pages :32 pages Book Rating :4.F/5 ( download)
Book Synopsis Fraud and abuse in the medicare and medicaid programs by : United States. Congress. House. Committee on Ways and Means. Subcommittee on Health
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 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:
Book Synopsis Fraud, Waste, and Abuse in the Medicare Pacemaker Industry by :
Download or read book Fraud, Waste, and Abuse in the Medicare Pacemaker Industry written by and published by . This book was released on 1982 with total page 216 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis Medicare Laboratory Payment Policy by : Institute of Medicine
Download or read book Medicare Laboratory Payment Policy written by Institute of Medicine and published by National Academies Press. This book was released on 2000-12-04 with total page 261 pages. Available in PDF, EPUB and Kindle. Book excerpt: Clinical laboratory tests play an integral role in helping physicians diagnose and treat patients. New developments in laboratory technology offer the prospect of improvements in diagnosis and care, but will place an increased burden on the payment system. Medicare, the federal program providing coverage of health-care services for the elderly and disabled, is the largest payer of clinical laboratory services. Originally designed in the early 1980s, Medicare's payment policy methodology for outpatient laboratory services has not evolved to take into account technology, market, and regulatory changes, and is now outdated. This report examines the current Medicare payment methodology for outpatient clinical laboratory services in the context of environmental and technological trends, evaluates payment policy alternatives, and makes recommendations to improve the system.
Author :National Academies of Sciences, Engineering, and Medicine Publisher :National Academies Press ISBN 13 :0309477891 Total Pages :399 pages Book Rating :4.3/5 (94 download)
Book Synopsis Crossing the Global Quality Chasm by : National Academies of Sciences, Engineering, and Medicine
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 Overcharged written by Charles Silver and published by Cato Institute. This book was released on 2018-07-03 with total page 587 pages. Available in PDF, EPUB and Kindle. Book excerpt: Why is America's health care system so expensive? Why do hospitalized patients receive bills laden with inflated charges that com out of the blue from out-of-network providers or demands for services that weren't delivered? Why do we pay $600 for EpiPens that contain a dollar's worth of medicine? Why is more than $1 trillion - one out of every three dollars that passes through the system - lost to fraud, wasted on services that don't help patients, or otherwise misspent? Overcharged answers these questions. It shows that America's health care system, which replaces consumer choice with government control and third-party payment, is effectively designed to make health care as expensive as possible. Prices will fall, quality will improve, and medicine will become more patient-friendly only when consumers take charge and exert pressure from below. For this to happen, consumers must control the money. As Overcharged explains, when health care providers are subjected to the same competitive forces that shape other industries, they will either deliver better services more cheaply or risk being replaced by someone who will.
Author :United States. Congress. House. Committee on Ways and Means. Subcommittee on Health Publisher : ISBN 13 : Total Pages :120 pages Book Rating :4.:/5 (327 download)
Book Synopsis Medicare Fraud, Waste, and Abuse by : United States. Congress. House. Committee on Ways and Means. Subcommittee on Health
Download or read book Medicare Fraud, Waste, and Abuse written by United States. Congress. House. Committee on Ways and Means. Subcommittee on Health and published by . This book was released on 1992 with total page 120 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis The CMS Hospital Conditions of Participation and Interpretive Guidelines by :
Download or read book The CMS Hospital Conditions of Participation and Interpretive Guidelines written by and published by . This book was released on 2017-11-27 with total page 546 pages. Available in PDF, EPUB and Kindle. Book excerpt: In addition to reprinting the PDF of the CMS CoPs and Interpretive Guidelines, we include key Survey and Certification memos that CMS has issued to announced changes to the emergency preparedness final rule, fire and smoke door annual testing requirements, survey team composition and investigation of complaints, infection control screenings, and legionella risk reduction.
Author :United States. Congress. House. Committee on Ways and Means. Subcommittee on Health Publisher : ISBN 13 : Total Pages :140 pages Book Rating :4.0/5 ( download)
Book Synopsis Health Care Waste, Fraud, and Abuse by : United States. Congress. House. Committee on Ways and Means. Subcommittee on Health
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:
Book Synopsis Medicaid Integrity Program by : United States. Government Accountability Office
Download or read book Medicaid Integrity Program written by United States. Government Accountability Office and published by . This book was released on 2012 with total page 46 pages. Available in PDF, EPUB and Kindle. Book excerpt:
