OVERVIEW: There are various forms of fraud that can be committed in a health care setting. Fraud not only impacts funding organizations—typically the federal government and consequently, the taxpayers—but also can have an impact on the quality of care delivered to individuals. This Case Assignment examines health care fraud, the penalties that are associated with fraud cases, and the role of Corporate Compliance Programs as a deterrent for fraud within health care organizations.
ASSIGNMENT: New Orleans woman sentenced to prison for role in $3.2 million health care fraud and kickback scheme. (2018). Retrieved from https://www.justice.gov/usao-edla/pr/new-orleans-woman-sentenced-prison-role-32-million-health-care-fraud-and-kickback
Sixteen individuals charged in $60 million Medicare fraud scheme. (2017). Retrieved from https://www.justice.gov/usao-ndtx/pr/sixteen-individuals-charged-60-million-medicare-fraud-scheme
Miami-Dade psychiatrist sentenced to prison for his participation in various fraud schemes. (2016). Retrieved from https://www.justice.gov/usao-sdfl/pr/miami-dade-psychiatrist-sentenced-prison-his-participation-various-fraud-schemes
For this module’s Case Assignment, choose one of the cases of Medicare or Medicaid fraud listed above. Discuss the elements of the case and the decision that was reached by the court; and identify the type(s) of fraud and the law/s that was/were broken. Analyze the penalty for the perpetrator and whether the outcome was appropriate.
Discuss how a Corporate Compliance Program can help minimize the risk of fraud for a health care organization.
You may research to find additional information on each case, as well as for general purposes for this assignment, but be sure to use only reliable sources
3 PAGES REQUIRED!/ APA FORMAT/ 3 PEER-REVIEWED REFERENCES REQUIRED
READINGS: Department of Justice and Federal Trade Commission. (1996). Statements of antitrust enforcement policy in health care. Retrieved from https://www.justice.gov/atr/statements-antitrust-enforcement-policy-health-care#CONTNUM_106
In the Matter of South Georgia Health Partners, et al., FTC Docket No. C-4100 (2003)
Decision and order: https://www.ftc.gov/sites/default/files/documents/cases/2003/11/sgeorgiado.pdf
Office of Inspector General, Health and Human Services. (2012, January 11). Compliance program basics [Video file]. Retrieved from https://www.youtube.com/watch?v=bFT2KDTEjAk
Office of Inspector General, Health and Human Services. (2012, January 18). Tips for implementing an effective compliance program [Video file]. Retrieved from: https://www.youtube.com/watch?v=w_g1bVT12Yg
Showalter, J. S. (2017). Competition and antitrust. In The Law of Healthcare Administration (pp. 469-496). Chicago, IL: Health Administration Press. Retrieved from the Trident Online Library.
Showalter, J. S. (2017). Fraud laws and corporate compliance. In The Law of Healthcare Administration (pp. 547-572). Chicago, IL: Health Administration Press. Retrieved from Trident Online Library.
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