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Author: Aspen Health Law Center Publisher: ISBN: Category : Business & Economics Languages : en Pages : 156
Book Description
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.
Author: Aspen Health Law Center Publisher: ISBN: Category : Business & Economics Languages : en Pages : 156
Book Description
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.
Author: Paul W. Shaw Publisher: ISBN: 9781663315007 Category : Fraud investigation Languages : en Pages : 775
Book Description
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.
Author: Malcolm K Sparrow Publisher: Basic Books ISBN: 0465010741 Category : Political Science Languages : en Pages : 306
Book Description
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.
Author: United States. Congress. Senate. Committee on Appropriations. Subcommittee on Departments of Labor, Health and Human Services, Education, and Related Agencies Publisher: ISBN: Category : Law Languages : en Pages : 64
Author: Charles E. Phelps Publisher: Routledge ISBN: 1351856340 Category : Business & Economics Languages : en Pages : 420
Book Description
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.
Author: United States. Congress. House. Committee on Ways and Means. Subcommittee on Health Publisher: ISBN: Category : Medicaid fraud Languages : en Pages : 32
Author: National Academies of Sciences, Engineering, and Medicine Publisher: National Academies Press ISBN: 0309477891 Category : Medical Languages : en Pages : 399
Book Description
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.
Author: American Dental Association Publisher: American Dental Association ISBN: 1941807712 Category : Medical Languages : en Pages : 60
Book Description
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: Aspen Health Law Center
Author: Aspen Health Law Center
Author: Paul W. Shaw
Author: Malcolm K Sparrow
Author: United States. Congress. Senate. Committee on Finance
Author: 
Author: United States. Congress. Senate. Committee on Appropriations. Subcommittee on Departments of Labor, Health and Human Services, Education, and Related Agencies
Author: Charles E. Phelps
Author: United States. Congress. House. Committee on Ways and Means. Subcommittee on Health
Author: National Academies of Sciences, Engineering, and Medicine
Author: American Dental Association