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At least 181 records · Page 10Linked to original sources
PubMed1995

Health care programs: fraud and abuse; revisions to the PRO sanctions process--HHS. Final rule.

This final rule revises and updates the procedures governing the imposition and adjudication of program sanctions predicted on recommendations of State Utilization and Quality Control Peer Review Organizations (PROs). These changes are being made as a result of statutory revisions designed to address health care fraud and abuse issues and the OIG sanctions process. In addition, this final rule sets forth new appeal and reinstatement procedures for practitioners and other persons excluded by the OIG based on a PRO recommendation.

Fraud↗
PubMed1997

Health care fraud and abuse: new weapons, new penalties, and new fears for providers created by the Health Insurance Portability and Accountability Act of 1996 ("HIPAA").

The Health Insurance Portability and Accountability Act of 1996 may well be the most significant increase ever in the federal government's health care fraud and abuse enforcement authority. This new authority coupled with increased scrutiny of the health care industry generally creates a compelling incentive for health care facilities to develop corporate compliance programs.

Career Mobility↗
PubMed1997

Health care programs: fraud and abuse; revised OIG exclusion authorities resulting from Public Law 104-191--HHS. Notice of proposed rulemaking.

This rulemaking addresses proposed revisions to the OIG's sanction authorities in conjunction with sections 211, 212 and 213 of the Health Insurance Portability and Accountability Act of 1996, along with other technical and conforming changes to the OIG exclusion authorities set forth in 42 CFR parts 1000, 1001, 1002 and 1005. These proposed revisions are specifically designed to expand the protection of certain basic fraud authorities, and revise and strengthen the current legal authorities pertaining to exclusions from the Medicare and State health care programs.

Career Mobility↗
PubMed1998

Compliance, medical records, and the FBI: preventing fraud and abuse.

The possibility of an investigation related to fraud and abuse is the last thing most people want to think about, but it's important to be prepared, just in case. The author gives some advice on how to react if your facility is the target of an investigation and points out some important steps to take to ensure compliance.

Facility Regulation and Control↗
PubMed1998

Fraud and abuse. Building an effective corporate compliance program.

In 1997, General Health System (GHS), a not-for-profit integrated delivery system headquartered in Baton Rouge, Louisiana, developed a formal corporate compliance program. A newly appointed corporate compliance officer worked with key GHS managers and employees to assess the organization's current fraud and abuse prevention practices and recommend changes to meet new regulatory and organizational requirements. Then a structure for implementing these changes was developed, with staff training at its core. The program required a significant initial outlay of financial and human resources. The benefits to the organization, however, including a greater ability to respond quickly and effectively to possible compliance problems and better organizational communications, were worth the investment.

Delivery of Health Care, Integrated↗
PubMed1998

Waste and neglect: fraud and abuse in the health care industry.

Fraud is not only illegal, but it also increases the cost of health care, reduces the quality of services, and, when the defrauded party is the government, raises taxes. Federal and state law enforcement agencies have tried (and failed) to combat the problem single-handedly, but without the assistance of health care industry members, law enforcement agencies will never find an effective solution. As health care professionals, nurse executives have a responsibility to their patients and their country to make every effort to rid their organizations of fraudulent behavior.

Cooperative Behavior↗
PubMed1998

Health care programs: fraud and abuse; revised OIG exclusion authorities resulting from Public Law 104-191--OIG. Final rule.

This final rule addresses revisions to the OIG's administrative sanction authorities to comport with sections 211, 212 and 213 of the Health Insurance Portability and Accountability Act (HIPAA) of 1996, along with other technical and conforming changes to the OIG exclusion authorities set forth in 42 CFR parts 1000, 1001, 1002 and 1005. These revisions serve to expand the scope of certain basic fraud authorities, and revise and strengthen the current legal authorities pertaining to exclusions from the Medicare, Medicaid and all other Federal health care programs.

Fraud↗
PubMed1998

Health care programs: fraud and abuse; revised OIG sanction authorities resulting from Public Law 105-33--OIG. Notice of proposed rulemaking.

This rulemaking proposes revisions to the OIG's exclusion and civil money penalty authorities set forth in 42 CFR parts 1001, 1002 and 1003, resulting from the Balanced Budget Act of 1997, Public Law 105-33. These proposed revisions are intended to protect and strengthen Medicare and State health care programs by increasing the OIG's anti-fraud and abuse authority through new or revised exclusion and civil money penalty provisions.

Fraud↗
PubMed1998

A summary of fraud and abuse issues affecting clinical research programs.

In an environment where the health care industry is under unprecedented scrutiny, it is important for all of those involved in the delivery of patient care and clinical research to be aware of and adhere to government grant requirements and billing practices. Fraud and abuse violations, no matter how minor they may seem, can result in substantial consequences for the grantee institutions and the investigators themselves.

Academic Medical Centers↗
PubMed1998

Making it a federal case. Suit alleges widespread fraud by Columbia, Quorum.

A federal whistleblower lawsuit unsealed last week alleges widespread Medicare fraud at two of the nation's largest for-profit hospital companies, Columbia/HCA Healthcare Corp. and Quorum Health Group--both relatives of Hospital Corporation of America. The case shows how hospitals' legal troubles have spread since the advent of Medicare's prospective payment system in 1984.

Fraud↗
PubMed1998

Health care fraud and abuse data collection program: reporting of final adverse actions--Office of Inspector General (OIG), HHS. Notice of proposed rulemaking.

This proposed rule would establish a new 45 CFR part 61 to implement the statutory requirements of section 1128E of the Social Security Act, as added by section 221(a) of the Health Insurance Portability and Accountability Act (HIPAA) of 1996. Section 221(a) of HIPAA specifically directed the Secretary to establish a national health care fraud and abuse data collection program for the reporting and disclosing of certain final adverse actions taken against health care providers, suppliers, or practitioners, and maintain a data base of final adverse actions taken against health care providers, suppliers and practitioners.

Data Collection↗
PubMed1983

Abuse of the elderly through fraud & deception.

Hard economic times combined with a longer life-span for the nation's elderly have resulted in substantial increases in abuse of the elderly through fraud and deception. Physical infirmities and reduced mental capacity make the elderly easy prey for unscrupulous individuals who view advancing age as an invitation to their own financial prosperity. Popular fraudulent practices and devices include "bait and switch" tactics, the "pigeon drop," and the "ponzy" scheme. The unwarranted transfer of an elderly person's property to a trusted friend or family member to "reduce taxes" or "avoid probate" may represent potential abuse, which can have devastating financial consequences in later years. Very often these abuses have national and international effects as distant family members summon financial and psychological support in the aftermath of the victim's anguish over such tragedies. This article identifies some of the areas of potential abuse and addresses available means of preventing their occurrence through timely legal advice and counsel.

Aged↗
PubMed1983

New proposed fraud and abuse regulations: severe penalties for unwary providers.

New proposed regulations on federal health care programs are targeted against fraud and abuse, a growing trend among providers. This article gives a legal analysis of the new laws and examines the administrative process enforced by the Inspector General's office. At the same time, the authors enumerate defense opportunities in the context of the new proposed regulations.

Costs and Cost Analysis↗
PubMed1985

Medicare and Medicaid programs; fraud and abuse--HHS. Final rule with comment period.

This final rule implements sections 2348 and 2370 of the Deficit Reduction Act respectively by limiting payment for services furnished to beneficiaries by a home health agency or hospice whose provider agreement has been terminated, and by expanding subpoena authority for civil monetary penalty hearings under Medicaid. In addition, this rule includes a series of technical changes to reflect the transfer of the responsibility for making fraud and abuse determinations from the Health Care Financing Administration (HCFA) to the Department's Office of Inspector General (OIG).

Crime↗
PubMed1988

Physician recruitment programs--fraud and abuse, tax, and antitrust considerations.

In today's competitive environment, physician recruitment incentive programs perform a valuable function for both hospitals and physicians, but fraud and abuse, tax, and antitrust laws impose significant restrictions on such programs. This article addresses some of the issues that hospitals and physicians must consider before participating in recruitment incentive programs.

Centers for Medicare and Medicaid Services, U.S.↗
PubMedDate not supplied

Healthcare industry "anxiously" awaits new Medicare fraud and abuse regulations.

The Medicare and Medicaid Patient Protection Act of 1987 (1) requires the government to specify, by regulation, particular payment arrangements among health care providers and practitioners that are legal under the Medicare "anti-kickback" statute. As there has been little guidance from the government in the past with respect to this matter, the healthcare industry anxiously awaits regulations implementing the new law and hopes ambiguities regarding arrangements which might constitute fraud and abuse will be resolved.

Crime↗
PubMed1989

"Fraud alert": joint venture arrangements.

The Office of Inspector General of the Department of Health and Human Services recently issued a special "Fraud Alert" identifying those characteristics of joint venture arrangements that it views as indicators of potentially unlawful activity. As discussed in this article, participants in joint ventures should examine their arrangements to see if one or more of the questionable features are present, and, if so, should take steps to eliminate them, to the extent possible.

Crime↗