Article Commentary: Penalties for health care fraud and abuse: January 2007-March 2008

2009 ◽  
Vol 140 (5) ◽  
pp. 625-628 ◽  
Author(s):  
Udayan K. Shah ◽  
Douglas R. Johnston ◽  
Gina Maisto Smith ◽  
Barbara E. Ziv ◽  
James S. Reilly
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Medical Equipment ◽  
Careful Consideration ◽  
The State ◽  
Care Providers ◽  
Health Care Fraud ◽  
Pharmaceutical Firms

This commentary details the providers, penalties, and affected regions resulting from US health care fraud and abuse prosecutions from January 2007 to March 2008. Database review found that over $3 billion in fines as well as incarceration in some cases were ordered for 21 convicted providers, 68 percent of whom were physicians, and to 41 nonproviders, most of whom were vendors of durable medical goods (36%), individual citizens (18%) and health care corporations (17%). Fewer claims were found against pharmaceutical firms (7%) and medical equipment manufacturers (4%). Most verdicts were in the state of Florida. False claims accounted for most of the violations for both providers and nonproviders. These severe repercussions of malfeasance should promote careful consideration and construction of the terms of engagement between health care providers, corporations, and payers.

MINNESOTA TAKES CONTROVERSIAL STEPS TO REFORM HEALTH CARE

PEDIATRICS ◽  
1994 ◽  
Vol 93 (4) ◽  
pp. 560-560
Author(s):  
J. F. L.
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Health Reform ◽  
Income Tax ◽  
The State ◽  
Care Providers ◽  
Practice Parameters ◽  
The Law ◽  
Health Legislation ◽  
Care Costs

When Minnesota legislators last spring passed health legislation that included a tax on health care providers, many physicians thought the state had gone too far. As the state begins to implement the law, however (physicians will begin paying the tax in 1994), those same physicians are realizing that their troubles may have just begun. The tax is only one part of a larger health reform package that promises to change the way Minnesota physicians practice. Under the law, for example, the state will assign physicians to some patients. The law also requires the state to develop practice parameters and controls on technology... Beginning in 1994, physicians will pay a 2% income tax on their gross revenues. The tax, which will not be levied on Medicare or Medicaid services or on physicians employed by managed care providers, will help pay for health insurance for the state's approximately 400,000 uninsured. Many physicians opposed the legislation because it will cut into their pay... And to achieve its goal of reducing health care costs by 10% a year for five years, the state will develop and implement practice parameters in an attempt to avoid ineffective treatment.

scholarly journals Senior healt-hcare fraud under investigation

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Nicole F. Stowell ◽  
Carl Pacini ◽  
Martina K. Schmidt ◽  
Nathan Wadlinger
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Well Being ◽  
Care Providers ◽  
Prevention Strategies ◽  
Effective Prevention ◽  
Content Type ◽  
Health Care Fraud ◽  
Increased Risk ◽  
The Usa

Purpose This study aims to increase awareness and educate the reader about health-care fraud targeting seniors in the USA to help stakeholders better understand, recognize and prevent this type of fraud. Design/methodology/approach This paper collects statistics on the current state of health care frauds committed against seniors, and examines related cases and laws. Findings The authors find this type of fraud is highly prevalent and expected to increase. Current laws preventing this fraud from occurring are multifold and complex. While prevention strategies through law enforcement have been somewhat successful, a reduction in resources may put seniors at an increased risk in the years to come. Research limitations/implications Without additional prevention strategies, the problem will likely escalate with a growing population of older adults. This study encourages further research into effective prevention strategies and methods to fight health-care fraud against seniors. Practical implications Health-care fraud and its associated costs pose a significant threat to the society and economy of the USA. Reducing this fraud will not only reduce the costs to the US economy but also improve the physical and mental well-being of senior victims, reduce their mortality and hospitalization rates and improve the public trust placed to health-care providers. Originality/value This study highlights how health-care fraud is committed against seniors. With the projected trend of an aging US population, educating stakeholders, increasing awareness and applying tools to protect seniors will be important to reduce the absolute scope of this problem in the future.

The State of Genomic Health Care and Cancer Are We Going Two Steps Forward and One Step Backward?

2011 ◽  
Vol 29 (1) ◽  
pp. 73-97 ◽  
Author(s):  
Karen E. Greco ◽  
Suzanne M. Mahon
Keyword(s):  
Health Care ◽  
Genetic Testing ◽  
Health Care Providers ◽  
The State ◽  
Access To Information ◽  
Care Providers ◽  
Genomic Information ◽  
Genetic Tests ◽  
Common Diseases ◽  
One Step

As the application of genomic information and technology crosses the horizon of health care into our everyday lives, expanding genomic knowledge continues to affect how health care services are defined and delivered. Genomic discoveries have led to enhanced clinical capabilities to predict susceptibility to common diseases and conditions such as cancer, diabetes, cardiovascular disease, and Alzheimer's disease. Hundreds of genetic tests are now available that can identify individuals who carry one or more gene mutations that increase their risk of developing cancer or other common diseases. Increased availability and directto-consumer marketing of genetic testing is moving genetic testing away from trained genetics health professionals and into the hands of primary care providers and consumers. Genetic tests available on the Internet are being directly marketed to individuals, who can order these tests and receive a report of their risk for numerous health conditions and diseases. Health care providers are expected to interpret these test results, evaluate their accuracy, address the psychosocial consequences of those distressed by receiving their results, and translate genomic information into effective care. However, as we move two steps forward, we are also moving one step backward because many health care providers are unprepared for this genomic revolution. A number of international education, practice, and policy efforts are underway to address the challenges health care providers face in providing competent genomic health care in the context of unprecedented access to information, technology, and global communication. Efforts to integrate standard of care guidelines into electronic medical records increases health care providers' access to information for individuals at risk for or diagnosed with a genomic condition. Development of genomic competencies for health care providers has led to increased genomic content in academic programs. These and other efforts will keep the state of genomic health care stepping forward as we face the challenges of health care in the genomic era.

scholarly journals A PERSPECTIVE OF PRIVATE HEALTH CARE PROVIDERS IN THE STATE OF MADHYA PRADESH ON ADOPTING KEY STRATEGIES OF INDIA HYPERTENSION CONTROL INITIATIVE

2021 ◽  
Vol 39 (Supplement 1) ◽  
pp. e385-e386
Author(s):  
Ashish Krishna ◽  
Anupam Khungar Pathni ◽  
Bhawna Sharma ◽  
Roopa Shivashankar ◽  
Suyesh Shrivastava ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
The State ◽  
Madhya Pradesh ◽  
Private Health Care ◽  
Care Providers ◽  
Hypertension Control ◽  
Control Initiative

scholarly journals LEGAL ENFORCEMENT OF STATE AID CONTROL IN THE FIELD OF HEALTHCARE: EXPERIENCE OF UKRAINE IN THE CONTEXT OF EUROPEAN INTEGRATION

2020 ◽  
Vol 73 (12) ◽  
pp. 2848-2854
Author(s):  
Antonina G. Bobkova ◽  
Andrii M. Zakharchenko ◽  
Yuliia M. Pavliuchenko
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health Care Providers ◽  
State Aid ◽  
The State ◽  
The European Union ◽  
Care Providers ◽  
European Union Law ◽  
Legal Enforcement ◽  
State Aid Control

The aim: The purpose of this article is to concretize the directions of improving legal support of control over the state aid in the field of health care. Materials and methods: The study analyzed the sources of the European Union law and legislative acts of Ukraine on the provision of state aid to business entities, relevant materials of the Antimonopoly Committee of Ukraine, including more than 20 decisions taken by this body based on the notification review results of the state aid provision in the field of health care. The methodological basis of the research consists of general and special methods of scientific research, in particular, dialectical, analytical-synthetic, system-structural, formal-logical, comparative legal methods. Conclusions: Based on the results of the study directions for improving legal support for state aid control in public health sector have been proposed, in particular, legal qualification of the activities of health care providers, determining whether certain types of public health activities belong to those that constitute a common economic interest and finalizing the criteria used to assess admissibility of state aid in this area.

Developing Public Policy for Sectarian Providers: Accommodating Religious Beliefs and Obtaining Access to Care

1996 ◽  
Vol 24 (2) ◽  
pp. 90-98 ◽  
Author(s):  
Kathleen M. Boozang
Keyword(s):  
Health Care ◽  
Access To Care ◽  
Health Care Providers ◽  
Religious Identity ◽  
Access To Health Care ◽  
Health Care Services ◽  
Religious Beliefs ◽  
Care Delivery ◽  
The State ◽  
Care Providers

The market changes sweeping the U.S. health care industry have a distinctive impact on communities that rely on religiously affiliated health care providers. When a sectarian sponsor subsumes multiple providers, its assertion of religious beliefs can preclude the provision of certain health care services to the entire community. In addition, the sectarian provider's refusal to offer certain services may violate state certificates of need, licensing, Medicaid managed care, or even professional liability law. This situation challenges both the provider and the state: the provider seeks adherence to religious law, and the state seeks compliance with its law and citizens access to health care.I propose that the state attempt to ameliorate tensions between civil and religious laws through negotiated accomodation. This concept encourages the sectarian institution to reassess its mission in the current market and to identify alternative avenues of health care delivery that will preserve patients' access to care without excessively diluting religious identity or beliefs.

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