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,
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In my representation of Stepford Hospital, I would make the initial argument that there was a lack of oversight and poor communication by the Principal Investigator, Dr. Ego, his entire clinical and administrative staff, Pretty Good Medical Devices (PGMD), and their trial associates. Also, it has now become evidently clear that all Dr. Ego wanted to do was utilize the hospital facilities for his own gain (Product, Monetary, and Reputation) and that he nor his staff cared about logistical or billing matters when it came to the overall clinical trial. His own statement to Nurse Q. Tam, “Not my problem, Connie, and not yours either. The geniuses over at the hospital can figure this out, and that’s what they’re paid to do. I have no idea how they bill their portion, and I could care less” (GWU Program Integrity Case Study, 2018) is a large representation of that. Furthermore, previous to our investigation, we at Stepford Hospital were kept in the dark about a grant from PGMD which was to cover the costs of follow-up CT scans. Before we self-reported to CMS, the fact remains that our actions DID NOT fit the “knowingly” definition provided in §3729. False claims. (a), (b), (c), and (d) with specific regards to §3729. False claims,(a), (b), (1), (A), (i) has actual knowledge of the information; (ii) acts in deliberate ignorance of the truth or falsity of the information; or (iii) acts in reckless disregard of the truth or falsity of the information; and (B) require no proof of specific intent to defraud (§3729. False claims, 2009). Once we were notified of a possible issue, our legal department issued an internal audit, identified the discrepancies, and reached out to CMS immediately after notifying the
In my representation of Stepford Hospital, I would make the initial argument that there was a lack of oversight and poor communication by the Principal Investigator, Dr. Ego, his entire clinical and administrative staff, Pretty Good Medical Devices (PGMD), and their trial associates. Also, it has now become evidently clear that all Dr. Ego wanted to do was utilize the hospital facilities for his own gain (Product, Monetary, and Reputation) and that he nor his staff cared about logistical or billing matters when it came to the overall clinical trial. His own statement to Nurse Q. Tam, “Not my problem, Connie, and not yours either. The geniuses over at the hospital can figure this out, and that’s what they’re paid to do. I have no idea how they bill their portion, and I could care less” (GWU Program Integrity Case Study, 2018) is a large representation of that. Furthermore, previous to our investigation, we at Stepford Hospital were kept in the dark about a grant from PGMD which was to cover the costs of follow-up CT scans. Before we self-reported to CMS, the fact remains that our actions DID NOT fit the “knowingly” definition provided in §3729. False claims. (a), (b), (c), and (d) with specific regards to §3729. False claims,(a), (b), (1), (A), (i) has actual knowledge of the information; (ii) acts in deliberate ignorance of the truth or falsity of the information; or (iii) acts in reckless disregard of the truth or falsity of the information; and (B) require no proof of specific intent to defraud (§3729. False claims, 2009). Once we were notified of a possible issue, our legal department issued an internal audit, identified the discrepancies, and reached out to CMS immediately after notifying the