Fraud and Abuse Law in the United States

2020 ◽  
Author(s):  
Joan H. Krause
Keyword(s):  
United States ◽  
Primary Care ◽  
Health Insurance ◽  
Affordable Care Act ◽  
The United States ◽  
Care Physician ◽  
Medicare Reimbursement ◽  
Patient Protection ◽  
Healthcare Needs ◽  
The Us

This chapter focuses on healthcare fraud, which remains a significant problem in the United States despite years of increased fraud enforcement. It describes the US federal government's anti–fraud activities, which include expanding the range and severity of laws targeting healthcare fraud. It also points out the role played by the United States' lack of a centralized, universal program of health insurance, which causes healthcare to be paid for by a variety of public, private, and hybrid sources. This chapter mentions the strategy of capitation as the strictest mechanism for managing care, in which a primary care physician receives a fixed per–patient payment in return for meeting the patient's healthcare needs during a set period of time. It also looks at changes made to Medicare reimbursement under the Patient Protection and Affordable Care Act (ACA) that reward providers for the “value” rather than the volume of services provided.

Better Than Nothing: Participant Experiences in Using a County Health Plan

2012 ◽  
Vol 34 (4) ◽  
pp. 13-18 ◽  
Author(s):  
Kimberly Rovin ◽  
Rebecca Stone ◽  
Linda Gordon ◽  
Emilia Boffi ◽  
Linda Hunt
Keyword(s):  
United States ◽  
Health Care ◽  
Health Insurance ◽  
Affordable Care Act ◽  
The United States ◽  
United States Government ◽  
Patient Protection ◽  
Access To Health ◽  
History Of ◽  
Better Than

The United States health care system has reached a crisis point, with 49.9 million Americans now living without health insurance (DeNavas-Walt, Proctor, and Smith 2011). The United States government has responded to this crisis in a variety of ways, perhaps the most visible being the enactment of the Patient Protection and Affordable Care Act (ACA) in March 2010. With a goal of expanding access to health insurance to 32 million Americans by 2019, the ACA marks an important moment in the history of United States health care reform with the potential to drastically change the United States health insurance landscape (Connors and Gostin 2010). The law delineates only general categories of required benefits and leaves it to each state to decide the specific benefits that will be provided by the insurers in their state (Pear 2011).

The Impact of the Affordable Care Act Medicaid Expansions on the Sources of Health Insurance Coverage of Undergraduate Students in the United States

2021 ◽  
pp. 107755872110158
Author(s):  
Priyanka Anand ◽  
Dora Gicheva
Keyword(s):  
United States ◽  
Health Insurance ◽  
Undergraduate Students ◽  
Affordable Care Act ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
The United States ◽  
Percentage Points ◽  
The Affordable Care Act ◽  
Medicaid Expansions

This article examines how the Affordable Care Act Medicaid expansions affected the sources of health insurance coverage of undergraduate students in the United States. We show that the Affordable Care Act expansions increased the Medicaid coverage of undergraduate students by 5 to 7 percentage points more in expansion states than in nonexpansion states, resulting in 17% of undergraduate students in expansion states being covered by Medicaid postexpansion (up from 9% prior to the expansion). In contrast, the growth in employer and private direct coverage was 1 to 2 percentage points lower postexpansion for students in expansion states compared with nonexpansion states. Our findings demonstrate that policy efforts to expand Medicaid eligibility have been successful in increasing the Medicaid coverage rates for undergraduate students in the United States, but there is evidence of some crowd out after the expansions—that is, some students substituted their private and employer-sponsored coverage for Medicaid.

Interpretative theories as roadmaps to constitutional identity: The case of the United States

2015 ◽  
Vol 4 (3) ◽  
pp. 289-327 ◽  
Author(s):  
OR BASSOK
Keyword(s):  
United States ◽  
National Identity ◽  
Affordable Care Act ◽  
Focal Point ◽  
The United States ◽  
American Identity ◽  
American Constitution ◽  
Patient Protection ◽  
American National Identity ◽  
Constitutional Identity

AbstractAs long as the American Constitution serves as the focal point of American identity, many constitutional interpretative theories also serve as roadmaps to various visions of American constitutional identity. Using the debate over the constitutionality of the Patient Protection and Affordable Care Act, I expose the identity dimension of various interpretative theories and analyse the differences between the roadmaps offered by them. I argue that according to each of these roadmaps, courts’ authority to review legislation is required in order to protect a certain vision of American constitutional identity even at the price of thwarting Americans’ freedom to pursue their current desires. The conventional framing of interpretative theories as merely techniques to decipher the constitutional text or justifications for the Supreme Court’s countermajoritarian authority to review legislation and the disregard of their identity function is perplexing in view of the centrality of the Constitution to American national identity. I argue that this conventional framing is a result of the current understanding of American constitutional identity in terms of neutrality toward the question of the good. This reading of the Constitution as lacking any form of ideology at its core makes majority preferences the best take of current American identity, leaving constitutional theorists with the mission to justify the Court’s authority to diverge from majority preferences.

scholarly journals PRM99 - TRENDS IN OPIOID PRESCRIBING IN PRIMARY CARE PHYSICIAN OFFICES IN THE UNITED STATES: 2006-2015

2018 ◽  
Vol 21 ◽  
pp. S372
Author(s):  
MY Alsheikh ◽  
E. Seoane-Vazquez ◽  
A Barrett ◽  
C Rakovski ◽  
LM Brown ◽  
...  
Keyword(s):  
United States ◽  
Primary Care ◽  
Primary Care Physician ◽  
The United States ◽  
Care Physician ◽  
Opioid Prescribing

What Is the Affordable Care Act a Case of? Understanding the ACA through the Comparative Method

2020 ◽  
Vol 45 (4) ◽  
pp. 677-691
Author(s):  
Holly Jarman ◽  
Scott L. Greer
Keyword(s):  
United States ◽  
Health Care ◽  
Welfare State ◽  
Affordable Care Act ◽  
Strong Support ◽  
The United States ◽  
The Us ◽  
The Affordable Care Act ◽  
Shed Light ◽  
The Welfare State

Abstract International comparisons of US health care are common but mostly focus on comparing its performance to peers or asking why the United States remains so far from universal coverage. Here the authors ask how other comparative research could shed light on the unusual politics and structure of US health care and how the US experience could bring more to international conversations about health care and the welfare state. After introducing the concept of casing—asking what the Affordable Care Act (ACA) might be a case of—the authors discuss different “casings” of the ACA: complex legislation, path dependency, demos-constraining institutions, deep social cleavages, segmentalism, or the persistence of the welfare state. Each of these pictures of the ACA has strong support in the US-focused literature. Each also cases the ACA as part of a different experience shared with other countries, with different implications for how to analyze it and what we can learn from it. The final section discusses the implications for selecting cases that might shed light on the US experience and that make the United States look less exceptional and more tractable as an object of research.

scholarly journals The Implementation and Evaluation of the United States Affordable Care Act

2019 ◽  
Vol 12 (1) ◽  
pp. 17-38
Author(s):  
David Schultz
Keyword(s):  
United States ◽  
Health Care ◽  
Affordable Care Act ◽  
Access To Health Care ◽  
Care Delivery ◽  
The United States ◽  
Health Care Delivery System ◽  
Health Care Outcomes ◽  
The Us ◽  
American Health Care

In 2010 the United States Congress adopted the Patient Protection and Affordable Care Act (“ACA”), more commonly referred to as Obamacare. The ACA was proposed by President Barack Obama while running for president and it was passed with a near straight party-line vote of Democrats in the US House and Senate in 2010. The ACA was meant to address several problems with the American health care delivery system, including cost, access and outcomes. This article describes the major features of the ACA including the context of the US health care system, evaluates the ACA’s implementation history and assesses its fate and future reforms throughout the presidency of Donald Trump. The overall conclusion based on its implementation is that while the ACA made significant reforms in terms of access to health care, it is not clear that it addressed affordability or began to improve health care outcomes in the US.

scholarly journals The impact of the Patient Protection and Affordable Care Act on insurance coverage and cancer‐directed treatment in HIV‐infected patients with cancer in the United States

Cancer ◽  
2019 ◽  
Vol 126 (3) ◽  
pp. 559-566 ◽  
Author(s):  
Kelsey L. Corrigan ◽  
Leticia Nogueira ◽  
K. Robin Yabroff ◽  
Chun Chieh Lin ◽  
Xuesong Han ◽  
...  
Keyword(s):  
United States ◽  
Affordable Care Act ◽  
Insurance Coverage ◽  
The United States ◽  
Patients With Cancer ◽  
Patient Protection ◽  
The Impact

scholarly journals Predictors of Primary Care Physician Practice Location in Underserved Urban or Rural Areas in the United States

2016 ◽  
Vol 91 (9) ◽  
pp. 1313-1321 ◽  
Author(s):  
Amelia Goodfellow ◽  
Jesus G. Ulloa ◽  
Patrick T. Dowling ◽  
Efrain Talamantes ◽  
Somil Chheda ◽  
...  
Keyword(s):  
United States ◽  
Primary Care ◽  
Primary Care Physician ◽  
Rural Areas ◽  
The United States ◽  
Care Physician ◽  
Physician Practice ◽  
Practice Location

scholarly journals Navigating payer heterogeneity in the United States: lessons for primary care

2017 ◽  
Vol 9 (3) ◽  
pp. 200 ◽  
Author(s):  
Winston Liaw ◽  
Daniel McCorry ◽  
Andrew Bazemore
Keyword(s):  
United States ◽  
Primary Care ◽  
Patient Safety ◽  
Public Funding ◽  
The United States ◽  
Public And Private ◽  
The Us ◽  
Private And Public

ABSTRACT With most providers accepting private and public funding, the US exemplifies hybridization, which results in both systemic benefits and harms. While this practice stimulates innovation, encourages practices to be efficient, and increases choice, it has also been linked to gaps in patient safety and overtreatment. We propose three lessons from the US for navigating a public and private system: hybridization allows for innovation; hybridization leads to administrative complexity; and if the costs of participation outweigh the benefits, practices may undergo dehybridization.

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