I have read a report from the Department of Justice, claiming it has recovered over $3.7 billion from false claims last year; $2.4 billion of that coming from the health care industry. The $2.4 billion contributes to an overwhelming $56 billion, which the Department of Justice has recovered since 1986 (Justice Department, 2017). The article went on to identify which positions within the health care industry contributed to the false claims, including drug companies, physicians, pharmacies, laboratories, and hospitals (Justice Department, 2017). The article continues by listing a number of large recoveries from the health care industry from 2017. A few of the recoveries mentioned in the article include, Shire Pharmaceuticals LLC of $900 million, Mylan Inc. of $465 million, and Life Care Centers of America Inc. of $145 million (Justice Department, 2017). Although the article mentions a number of other categories in which fraudulent money was recovered, but the healthcare industry was by far the largest category. …show more content…
One off-topic but interesting reported fraud came from one of Elon Musk’s companies, Solar City.
The company deals will solar energy and works closely with Musk’s other two companies, Tesla, which provides batteries for the solar panels, and SpaceX, which invests a large amount of liquid asset, to form a financial triad. Solar City apparently oversold its capability as a renewable energy source in order to secure a larger grant and now, in addition to repaying the grant money, it can no longer seek funding under the same provisions (Justice Department, 2017). It would be interesting if this provision applied to the healthcare
industry. Do you believe that the penalties for health care fraud are harsh enough or the recovery process is rigid enough? Looking at other industries, entire lines of funding may be cut permanently, where as in the health care industry fines are levied and staff is relieved. It seems to me that in order to keep funding to larger healthcare organizations, such as hospitals, the penalties are harsher on the individual than the organization. Another industry which seems to have similar penalties is the banking industry. In light of the Wells Fargo scandal, in which employees opened false accounts, the bank was fined, the false accounts were closed, and the Chief Executive Officer was relieved, but the bank itself was able to continue operations. The obvious argument to permanently cutting funding to a health care organization would be that the loss of funding would cause more harm than good, but it could also be argued that it would force organizations to develop a stronger review system. I do not foresee this changing because the potential for harm is greater than the potential good, which would come from reforming the system. Do you have any thoughts on more aggressive penalties versus the wellbeing of the organization?
Estimated annual revenue from U.S. drug trade is more than $3 billion, just short of Fortune 500
HealthSouth is one of the nation’s largest healthcare providers specializing in rehabilitation. HealthSouth was founded by Richard M. Scrushy in 1984 and went public in 1986. Scrushy served as its Chairman of the Board from 1994 to 2002. The company was incorporated in January 1984 as Amcare Inc. before its name was changed to HealthSouth Rehabilitation Corporation in May 1985. In January of 2003, Mr. Scrushy reassumed the position of CEO.
Along the same lines as the capability gap for bundled payment models, ACOs are experiencing a similar need. CMS reported the financial results for more than 300 ACOs in August of 2015, and together, the ACOs generated savings of over $400 million. Despite these aggregate savings, more than 40% of those ACOs increased spend relative to their baseline expenditure. (Source: CMS, Medtronic analysis) As a result, there is significant opportunity for Medtronic to leverage the breadth of its product line and VBHC capabilities to play a role in bridging care settings and connecting disparate care teams in order to improve outcomes and lower costs over a longer time
Claims sent to the insurance companies could be rejected or denied. A health care facility is there to help people with their health, but they are a business that needs income to stay in business. If a medical facility or physician files a claim that is incorrect the Center for Medicare and Medicaid Services may get involved, this could mean audits, fines, or worse. Medical coding and billing are very precise and detailed work where mistakes can cause serious problems.
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).”
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 fraud perpetrated against the federal government3. The purpose of the lawsuit entered by Franklin would ultimately seek retribution to the United States for the millions of dollars spent by Medicaid for the medication Neurontin that was prescribed by physicians under fraudulent
Rising health care costs have caused a national crisis, and all agree we must embrace reform. President Obama has initiated his national health care plan in the hopes of decreasing some of the inflated costs. When attempting to resolve this issue, one must always address the root of the problem. A large portion of these inflationary costs stem from malpractice lawsuits, and so begins the debate for tort reform: legislation which would cut the costs of health care by reducing the risk of civil litigation and exposure to fraudulent claims (“What”). However, the real factor at hand and the real cause of the industry’s high costs does not come solely from the cost incurred from these lawsuits, but from over-expenditures on the part of doctors, who over-test and over-analyze so as to safeguard themselves from the threat of malpractice lawsuits. Thus, large public support exists for tort reform. While the proposed legislation enacted through tort reform could cut the costs of health care and positively transform the industry, it is ultimately unconstitutional and could not withstand judicial scrutiny.
Mount Sinai St. Luke’s sued following HIPPA ViolationThey’re being sued for faxing patient PHI to his employer, a reported HIPPA violation that has already resulted in an OCR HIPPA settlement. St. Luke’s impermissibly disclosed PHI of two identified patients when Spencer Cox staff members faxed one individual’s PHI to his workplace and the other individual’s PHI to an office at which he volunteered. The type of PHI involved was specifically information about HIV, AIDS, and mental health. They say the impermissible disclosures was breached. Despite admitting its wrongdoing and paying the government $387,000, they’re also getting sued for negligence and negligence infliction of emotional distress. Because the individual had not told the majority
Collectively, the Department of Health and Human Services and the Department of Justice work to reduce healthcare fraud and investigate dishonest providers and suppliers. The Health Care Fraud Prevention and Enforcement Action Team recouped almost 3 billion in fraud, this year alone. Also, aggressive strategies exist to eliminate Medicare prescription fraud. Patients abusing or selling painkillers received by visiting several doctors and obtaining multiple prescriptions costs Medicare millions annually. Fraud affects everyone, preventing it requires government officials and citizens diligently working together.
"Tenet Healthcare Corporation, through its subsidiaries, owns and operates acute care hospitals and related health care services" (Tenet, 2007) "On September 27, 2006, Tenet Healthcare Corporation signed an annual update of its ongoing corporate integrity agreement (CIA) with the Office of Inspector General (OIG)" (Jones, 2007, p. 7). Tenet, as are many other healthcare organizations, is faced with “inadequate medical record documentation; poorly executed patient informed consent; inadequate patient education; poor physician-patient communication; lack of medical necessity for performed medical services; and improper performance of medical services” (Jones, 2007, p. 8).
HealthSouth is a large healthcare company with many rehabilitative-type as well as outpatient facilities across the U.S. The company was involved in a major corporate accounting fraud scandal around 2003-2004. HealthSouth’s founder, Richard Scrushy, was indicted for using corrupt accounting practices and forcing others to alter books and overstate earnings. Scrushy’s fraudulent activities total in value up to as much as $4.6 billion. According to Walter Pavlo of Forbes, “CEO Richard Scrushy was the first executive to be tried under the Sarbanes-Oxley Act for cooking the books” (2012). While many involved served prison time, Scrushy was acquitted of the accounting fraud, only to later serve time in jail for politically-related charges (Pavlo
According to Harry A. Sultz and Kristina M. Young, the authors of our textbook Health Care USA, medical care in the United States is a $2.5 Trillion industry (xvii). This industry is so large that “the U.S. health care system is the world’s eighth
Rising medical costs are a worldwide problem, but nowhere are they higher than in the U.S. Although Americans with good health insurance coverage may get the best medical treatment in the world, the health of the average American, as measured by life expectancy and infant mortality, is below the average of other major industrial countries. Inefficiency, fraud and the expense of malpractice suits are often blamed for high U.S. costs, but the major reason is overinvestment in technology and personnel.
The most controversial case of fraud in history left more questions than answers. Bernard Madoff, with his company "Investment Securities LLC", chose the easy way to give him greater gains scamming people. Using the prestige he had and giant Ponzi scheme. That was how he was creating his fraud. Madoff did not steal the money immediately but was paid the promised returns with money paid by the entry of new customers paying its customers their profits and not realize and would not take legal action, this intelligent man or charlatan achievement out this scam film for over 20 years. Madoff achieving the greatest fraud in history with losses of more than 50,000 million alone was compared with the Enron case. In June 29, 2009, he was sentenced to 150 years in prison.
United States policy and legislature developments regarding solar energy include the SunShot Initiative, the American Recovery and Rehabilitation Act (ARRA) of 2009, and the Energy Improvement and Extension Act (EIA) of 2008. The SunShot Initiative was enacted in February 2011 and aims to “make the total cost of solar energy fully economically-viable for everyday use, so that all Americans can benefit from this clean renewable energy source.”1 The ARRA invested $114 million into the solar energy industry for the research and development of photovoltaic systems, solar power concentration and high penetration solar deployment.2 The ARRA and EIA created tax credits for homeowners and businesses for their investment in solar power.3 The implementation of these policy and legislature initiatives promote the growth and development of the solar energy industry and therefore positively impact Sun Edison.