00 or imprisonment for not more than five years, or both.
Analysis of Current Fraud legal analysis of the current fraud committed in the Medicare and Medicaid programs indicates that reforms are in place to detect this fraud, and the involvement of governmental, local and federal police and investigation authorities has increased as well. For example, the National Center Policy for Analysis (2001) reports that 350 FBI agents are now investigating a record 2,300 potentially fraudulent cases in the medical industry. In addition, various government antifraud units are being allowed to tap into the Medicare trust fund for the first time to fund their budgets; $104 million for 2001 and more than $200 million for 2002. As a result of the high volume of Medicare and Medicaid fraud, in the past few years investigators have shifted the emphasis in their investigations from small amount abusers to large medical organizations and institutions, some of which have been known to bill Medicare for patient treatments which were never performed or equipment which was never ordered or used. The health programs most concentrated on by investigators are those that have grown rapidly in the past few years, and Medicare's home healthcare program, where bills have tripled in five years.
Recommendations to prevent the high volume of fraud committed in the Medicare and Medicaid systems include a system of checking to see whether claims are accurate and legitimate, instead of making sure that claims are filed in a standardized process, which is what the government has previously focused on. The Citizens Against Government Waste (CAGW) argues in a recent report that the best way to cut fraud in Medicare is to expose it to the discipline of the market. CAGW recommends replacing the current system with a program to allow beneficiaries to choose from private health insurance plans (National Center for Policy Analysis, 2001). According to this group, competition would tend to drive up the quality of medical care while keeping a lid on costs....
Medicaid and Medicare Fraud Describe health news story combating health care fraud Medicare Medicaid• Examine evaluate corporate structure governance, culture, focus social responsibility • Recommends Medicare and Medicaid fraud: An overview Medicare and Medicaid fraud: An overview While there is still little consensus regarding the best ways to go about enacting healthcare reform, one issue that unites both Democrats and Republicans is the need to eliminate Medicaid and Medicare waste, fraud and abuse. According
President George Bush proposed a two part strategy with initial implemented drug coverage to low-income beneficiaries coupled with a White House task force to develop a plan to reform Medicare (Health Policy, 2001). Under this plan beneficiaries with income 135% below the national poverty guidelines would be eligible for full prescription drug coverage and a sliding scale would be provided for those under 175% (Health Policy 2001). The most controversial
Medicare and Medicaid Services (CMS), previously the Health Care Financing Administration (HCFA), that by the time 2011, health care expenditure will arrive at $2.8 trillion, as well as it will bill for 17% of the Gross Domestic Product. As a result, it is no revelation that white-collar offenders observe health care deception as a rewarding effort. Certainly, the General Accounting Office ("GAO") quotes that such deception accounts for up
Amerigroup Illinois Inc. Fraud CaseAmerigroup Illinois Inc. was found guilty in 2006 under the Federal Claims Act and the Illinois Protection Act. Amerigroup and its subsidiaries denied enrolling pregnant women and unhealthy patients in its managed care program in Illinois. Amerigroup received payment from the state and federal governments to operate a Medicaid health care program for low-income earners (Department Justice, 2008). Amerigroup was mandated by law to enroll all
Fraud and Abuse Case Healthcare fraud and abuse continues to threaten the country, costing the facility billions of dollars per year. Brodeur, (2007) stated that fraud is something difficult to understand because it is a contagious issue. Healthcare fraud and abuse according to Brosman & Roper (2007) is the most profitable thing one can take part in if he/she is a crook, it avoid all channels and legal procedures, in nutshell,
Medicaid Health Care Assistance How does the organization fund its programs? Medicaid was developed for the sole purpose of providing health care services to low income individuals and families. For those people that cannot afford to pay for these services, the program makes it possible for you to get the treatment you need when obtaining them is challenging (based upon financial considerations). To qualify for this entitlement program there are a number
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