False Claims Act and Pharmaceuticals Health care fraud cases continue to be problematic for health care systems and providers across the United States. According to Pozgar (2012), these cases not only pose financial burdens on the accused, but may also lead to unnecessary risks to patients. A violation against the Federal False Claims Act, 31 U.S.C. §§ 3729-33, is one example of health care fraud that often enters into a settlement agreement. It is important to mention violations against the Federal
A whistleblower is a person who exposes misconduct, alleged dishonest or illegal activity occurring in an organization. A whistleblower can be classified for violation of a law, rule, regulation or a direct threat to public interest, such as fraud, health and safety violations and corruption. The first protection law for whistleblowers in the United States was on July 30, 1778. The Continental Congress had an unanimous vote. In 1777 Richard Marven and Samuel Shaw blew a whistle, they suffered
Sharon Watkins earned her 15 minutes of fame the honest way, as the Enron employee who blew the lid off of then CEO Ken Lay's debauchery. But for every celebrated whistleblower, there are hundreds who remain in the shadows. And for good Samaritans who do tell their tale, the price they pay can be exorbitant. Whistleblowers perform in many careers and are found at all levels of an organization: scientists and secretaries, lawyers and paralegals, managers and staff, security personnel and computer
History of Whistleblowing The definition of a whistleblower is a past or pesent employee or member of an organization, who reports misconduct to people or entities that have the power and presumed willingness to take corrective action, or to notify the general public of wrongdoing. In most cases, whistleblowers are employees of the ogranization but can be employees of government agencies as well. Normally the misconduct being reported is a violation of law, rule, regulation and/or a direct threat
is one of my favorite actors – and as far as I’m concerned everything he touches turns to pure gold. He became a full-blown household name after his masterful work in Schindler’s List, but in my book, he will forever be etched in my imagination as Qui-Gon Jinn from Star Wars: The Phantom Menace. Don’t get me wrong – he’s been apart of some historically terrible movies, including The Phantom Menace, along with films like Battleship, The Haunting, and The Nut Job. Still, Neeson’s best work outweighs
Native American version, "The Rough-Faced-Girl", to a Vietnamese version, "Tam and Cam." The different versions may be based on very distinct beliefs, but they all have one thing in common, that being that they all engage in the moral imagination that good always overcomes evil. That being said, each story still emphasizes on different aspects of spirituality, magic, miracles, and outcomes. In the Vietnamese version of Tam and Cam, the aspect of spirituality can clearly be seen throughout the various
Becoming a “whistleblower” in what is legally known as a “qui tam” lawsuit, a private individual may collect up to 30 percent of the amount recovered, depending on how the case is prosecuted. “Qui tam” is an abbreviated Latin phrase “qui tam pro domino rege quam pro se ipso in hac parte sequitur,” which means “Who sues on behalf of the King as well as for himself.” You may report potential instances
Healthcare fraud can happen when there are deceitful care providers who do not have their patients’ best interest at heart. There are many different types of healthcare fraud such as, unnecessary or duplicate tests and procedures, to hacking into a patient’s personal medical records to submit false claims ("Healthcare Fraud", 2017). According to, the National Health Care Anti-Fraud Association the most common kind of healthcare fraud are: Medically performing unneeded services for the sole purpose
Stark began as a way to combat the abuse of doctors referring patients to clinics for tests in which they had a financial interest. Today it primarily deals with the hospital level and has seen compliance gained through the use of qui-tam lawsuits brought by non-governmental relators. Subpart A of this section will lay out the creation of Stark, the initial statute that created it and the many implementation phases and alterations it has gone through in its twenty-five plus year history. Subpart
particular types of professionals, but they failed to disclose violations of regulations pertaining to the qualifications and licenses of staff members (Universal Health Services, Inc. v. United States Ex Rel. Escobar, 2016). Respondents filed a Qui Tam suit, after a teenage beneficiary at a Massachusetts’ Medicaid program had died from a seizure (Universal Health Services, Inc. v. United States Ex Rel. Escobar, 2016). The young girl had been diagnosed, by an unlicensed staff member, with bipolar
II. Class Action litigation In order to bring a class action litigation in this case there are some benefits and challenges of bringing this type of class action. The class action is “an exception to the usual rule that litigation is conducted by and on behalf of the individual named parties only” . The class action litigation should refer to Federal Rules of Civil Procedure Class Action and to the Class Action Fairness Act . Based on the rule 23 there are some preconditions for class actions. In
The term qui tam is used as a writ in which a private citizen who assists in the prosecution is entitled to receive a portion of any monetary penalties levied . This also allows a private individual, termed “whistle-blower”, to use the False Claims Act (FCA) to present
The Stark Law Some federal statutes address fraud in government health care programs, and many of these laws vary considerably (Krause 2004). Some of these laws specifically target health care fraud. Example of the laws that the government direct at inappropriate health care activities includes the “Medicare and Medicaid Anti-Kickback Statute and Ethics in Patient Referrals Act (EPRA).” In 1989, Congress enacted the Ethics in Patient Referrals Act. Commonly known as Stark law, Congress named
Part: A Whistleblowers Protection Laws in Australia In Australia, there are several states and territories have some form of whistleblower protection legislation. These include the South Australian Whistleblowers Protection Act 1993, the Queensland Whistleblower Protection Act 1994, the ACT Public Interest Disclosure Act 1994, and the NSW Protected Disclosures Act 1994. Furthermore that Western Australia has the more limited Official Corruption Commission Act 1988. The Queensland Whistleblower Protection
M. Tullius Cicero orator et C. Antonius est consules anno ab urbe condita sexcentesimo nonagesimo primo. Hoc erat baculus rei publicae Romanorum olim supra a perpetuum honore in Senatu, qui fecit statutos, statuit consules et iudicit cuncti cives. Consulatum datur impunitam e cunctis sceleris a aut ante honorem datum est aut cum honore. Consules mutatus est quotannis ut aliquis e agens ut tyrannis aut regis detineatur, sciens ante scelera ac interfectos cum primo septem regis Romanorum, quorum finum
Jay Scott Traylor was driving on a highway in North Carolina when his car struck a guardrail that was fitted with an ET-Plus end terminal. The terminal, manufactured by Trinity Highway Products, LLC, comprised three main components—an impact plate, guide channels, and an extruder head. When attached to the end of a standard guardrail, the unit was designed to absorb and dissipate crash forces by permitting the guardrail to be extruded through the unit’s head and flattened out into a ribbon. . [Traylor
In the case of United States ex rel. Geraldine Petrowskivs. vs Epic System Corporation, Geraldine Petrowski worked as a the Supervisor of Physician’s Coding at WakeMed Health from 2008 until 2015. She was then trained to be a charge capture analyst for Epic’s billing charge capture system. After that she went on to work as a hospital liasion for the implemention of Epic at WakeMed Health. In 2015 Petrowski alleged that a glitch in Epic’s billing system had caused hundreds of millions of dollars
U.S. Department of Justice: http://www.stopmedicarefraud.gov/aboutfraud/index.html Baum, Hedlund, Aristei & Goldman, P.C. (2010, November). How Does Medicare and Medicaid Fraud Affect You. Retrieved December 10, 2011, from Whistleblower Claims Qui Tam Litigation: http://whistleblower-claims.com/government-healthcare-fraud.php Department of Health and Human Services. (2011, October 1). Protecting Medicare and You from Fraud. Retrieved December 10, 2011, from Medicare.gov The Official U.S. Government
Introduction of Coding Coding is best described as a process of using alphabetical and numerical values that are connected to clinical documentation that can identify a patients’ diagnosis and what procedures that were used during an encounter. Coding serves as a communication log to providers so that they can keep up with the payments that are received for each patient. There are several different types of coding in the health care industry. Such as, inpatient coding which is conducted while
unhappy as Catullus demonstrates with both his word choice and meter. Catullus ends his eighth poem by insulting Lesbia, whom he had showered with compliments and adoration previously. Bitterly Catullus writes, "Scelesta, vae tē! Quae tibī manet vīta? / Quis nunc tē adībit? Cui vidēberis bella?" ("Wicked one, woe to you! What life awaits you? / Who will approach you now? To whom will you seem pretty?") (Catullus 8: 15-16). His admonishments represent a complete shift from his attempts to woo her in earlier