Case Study On Medicare Fraud

Decent Essays
Thank you for your post. I found this case on Medicare/Medicaid fraud orchestrated by Sajid Javed via pharmacy/pharmaceutical to be interesting. In addition to your post, not only were there 301 various healthcare professionals and nine pharmacies participating in the fraud, but this fraud occurred throughout multiple US states within 36 federal districts, especially the following: Southern District of Florida; Tampa, Orlando, and the Middle District of Florida; New York; Missouri; and California (DOJ, 2016; Ross, 2016).
While the amount of fraudulent activity and Medicare scheming is shocking, it is, unfortunately, not surprising. In fact, billing for unnecessary or not rendered services is the top common healthcare provider fraud scheme

Related Documents

  • Decent Essays

    1. DaVita Health Care partners were accused of using more medicine vitals or unnecessary spreading medicine dosages across multiple treatments. They were allegedly doing this knowing that Medicare would pay for this “unavoidable” waste. A nurse and a Dr. that worked together noticed that expensive medicine was just being thrown away. These two men were upset this was happening and when nothing was being done to change it they filed a whistleblower case.…

    • 348 Words
    • 2 Pages
    Decent Essays
  • Decent Essays

    Marsha McMillen Unit 3 Healthcare Compliance Assignment Discuss what you would do as the administrator of this hospice and the five nurses worked for you. If I had been the administrator for this hospice, I would have trained my nurses in the importance of not committing fraud. I would have been very adamant about teaching my staff about the consequences of not being compliant in following the rules and law in reference to fraud. We would have had meetings to go over the compliance rules at least once a week.…

    • 299 Words
    • 2 Pages
    Decent Essays
  • Decent Essays

    Jerry Bullard was involved in healthcare fraud, it was one of the largest medicare fraud schemes in history tha cost the government $375 million over six years. Jerry C. Bullard was responsible for $583,688 of that. The federal judge determined he owed $317,779 in restitution. Jerry Bullard pled guilty in February 2012 to a single count of conspiracy to commit healthcare fraud.…

    • 187 Words
    • 1 Pages
    Decent Essays
  • Superior Essays

    In order to insure successful and systematic reaping of the bills set out, many not-for-profit hospitals erected chillingly uncharitable collection policies. According to the Cases in Healthcare Finance textbook, “not-for-profit hospitals often intimidate and harass uninsured patients through ‘goon-like and predatory collection tactics that frequently scar the patient for life…” (Ch.5, p.238). Frightening consequences awaited patients who could not, in a restricted time period, pay their inflated bill. The insurance providers would often seize a patient’s key assets like cars or threaten to foreclose on their houses, turning a minor medical procedure into a life-collapsing nightmare. Moreover, in a WSJ article published in the early 2000’s, investigative reporters concluded that the health care providers in question “did not tell the uninsured about charity care, did not offer charity care, did not discount bills to the uninsured and aggressively pursued payment”.…

    • 894 Words
    • 4 Pages
    Superior Essays
  • Improved Essays

    Medicare Coverage: A Case Study Heidi is a 72 year-old female who is hospitalized for 70-days after experiencing a stroke and further complications of a deep vein thrombosis of the leg and pulmonary embolus. Her current insurance includes Medicare Part A and B without Medicaid or a Medigap policy. While in the hospital she is treated by both a hospitalist and neurologist.…

    • 973 Words
    • 4 Pages
    Improved Essays
  • Improved Essays

    The IG MPI Investigations Division conducts investigations of Medicaid providers regarding allegations of Fraud, Waste and Abuse in the Medicaid program. Referrals can come from: • Medicaid provider complaints. • Self-Initiated referrals based on information obtained from data queries, sister agencies, provider and community outreach or other external sources. • Financial audits which determine funds were not used as intended or which identify overpayments and disallowed costs.…

    • 585 Words
    • 3 Pages
    Improved Essays
  • Improved Essays

    Stepford Hospital Case

    • 1547 Words
    • 7 Pages

    With the inception of the Patient Protection and Affordable Care Act (ACA) the Centers for Medicare & Medicaid Services (CMS) have really made even more of an effort to scale back on physician based Medicare/Medicaid fraud. These fraudulent cases come in all different manners from physicians and their practices knowingly defrauding the government to ongoing fraud which was never caught or knew they were committing fraud. Unfortunately CMS possesses little to no leniency for the infractions committed with most penalties coming in the monetary form. My task with this assignment is to break down a series of questions with specific answers as they pertain to our example and specific federal statutes (Federal Anti-Kickback Statute and Regulations,…

    • 1547 Words
    • 7 Pages
    Improved Essays
  • Great Essays

    Medicare Part A Case Study

    • 1245 Words
    • 5 Pages

    Medicare (Title 18) is a program that provides health care to individuals who are 65 years or older, disabled, or suffer from kidney failure. Medicare has a basic four-part structure: Part A, which is hospital insurance, Part B, which is supplementary medical insurance, Part C, which is Medicare advantage, and Part D, which is prescription drug coverage. Part A and B make up what is known as traditional Medicare. Part A concerns hospital insurance, this is financed by payroll taxed through employers and employees. Part A pays for a portion of inpatient hospitalization, nursing care, home health care, and hospice.…

    • 1245 Words
    • 5 Pages
    Great Essays
  • Decent Essays

    John Derek Haines

    • 521 Words
    • 3 Pages

    John Derek Haines, Forefather Of Addiction Canada Charged With Fraud For Hiring Fake Doctors Most medical providers are law-abiding, who work hard towards achieving improvement in their patients' health. However, a few like John Haines, Forefather of Addiction Canada, want to illegally increase the size of their bank accounts. The most talk about fraud of the time came in to the media lime light when the Ontario Provincial Police charged John Haines, the owner of a renowned chain of addiction treatment centers with cheating patients of up to $6.1 million. People choose addiction centers because these centers provide hope.…

    • 521 Words
    • 3 Pages
    Decent Essays
  • Improved Essays

    Barbara Reuter Fraud

    • 669 Words
    • 3 Pages

    She was also very skillful in convincing the doctors that was a real Medicaid patient. A contractor for Washington State noticed duplicate billing and was alerted to the fact that something fishy was going on and notified the insurance agency in 2007.…

    • 669 Words
    • 3 Pages
    Improved Essays
  • Improved Essays

    Stark Law Case Study

    • 436 Words
    • 2 Pages

    There is an issue with the overspending of health care as it is, but to compromise the care which is being received by performing fraud and abusing the laws is ethically wrong. I believe that Dr. S. and Dr. V. knowingly interpreted the law into their own definitions resulting into…

    • 436 Words
    • 2 Pages
    Improved Essays
  • Improved Essays

    Managed Care is a health care delivery system set up to manage cost, quality, and utilization. Medicaid Managed care allows for the delivery of Medicaid health benefits and additional services through contracted arrangements between Medicaid agencies and Managed Care Organizations (MCOs), that accept a set number per member per month (capitation) payment for services. By contracting with various types of MCOs to deliver Medicaid program services to beneficiaries, states can reduce Medicaid program costs and manage utilization of healthcare services. Keep in mind the goal is to improve health plan performance, quality, and outcomes.…

    • 972 Words
    • 4 Pages
    Improved Essays
  • Improved Essays

    Economical The VA is infamous for misappropriation of funding, which stems from two main sources: management flaws and lack of accountability. One of the most notable incidents of mismanagement causing extreme funding waste is the “$6.1 million” the House Committee on Veterans Affairs found the VA Human Resources Department (HR) wasted on two conferences in Orlando, and of this 6.1 million “$97,906” contributed to frivolous promotional items. The financial heads of the VA failed to keep a watchful eye over the VA HR department, which only lead to the described misappropriation. Furthermore, management flaws lead to an unreasonable increase in conference expenditures. This funding has gone into construction projects that are either overly extravagant for a government facility or costing “$1.5 billion” due to neglectful delays according to the Government Accountability office (Devine).…

    • 1070 Words
    • 5 Pages
    Improved Essays
  • Great Essays

    Healthsouth Scandal Essay

    • 2186 Words
    • 9 Pages

    HealthSouth was what seemed to be an ordinary striving medical business. Some would even say it was the most successful in its field , but unlike other corporations, it had a foul secret. All the grand success that HealthSouth was known for was a lie, a mask to hide what was going on behind the scene, hidden from the public eye. A secret so well hidden, that it went unnoticed for years. A secret so large it broke not only the law but several accounting principles.…

    • 2186 Words
    • 9 Pages
    Great Essays
  • Superior Essays

    Healthcare fraud is becoming an immense problem in today’s society. When a health care provider, health suppliers, and private health companies purposely bill Medicare or Medicaid for supplies or services that were not given it is considered healthcare fraud. For example another form of fraud is when a person uses another person’s Medicare/Medicaid card…

    • 1489 Words
    • 6 Pages
    Superior Essays