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PubMedDate not supplied

Reports uncover disreputable charges of fraud in records.

Recent articles in the media have disclosed charges of unethical practices related to tampering with patient medical and administrative management records to enhance the institution's stature in the eyes of accrediting and quality assurance bodies, and of questionable practices regarding referrals and insurance abuse at psychiatric facilities. The following articles and regulations that have emerged summarize some of these specific charges and efforts to stem these practices.

Accreditation↗
PubMed1992

Fitness campaign or fraud scheme? Postal inspector, state of California investigating promotion that may have cost hospitals $1 million.

The U.S. postal inspector and California authorities are investigating whether a San Francisco-based company called the National Fitness Campaign may have bilked more than 120 hospitals across the country out of nearly $1 million through a physical fitness and wellness promotion. Since 1990, scores of hospitals have paid thousands of dollars for shabby, incomplete or, in many cases, non-existent exercise equipment.

California↗
PubMed1992

Medicare and state health care programs: fraud and abuse; safe harbors for protecting health plans--HHS. Interim final rule with request for comment.

In accordance with section 14 of the Medicare and Medicaid Patient and Program Protection Act of 1987, this interim final rule establishes two new safe harbors and amends one existing safe harbor to provide protection for certain health care plans, such as health maintenance organizations and preferred provider organizations. The first new provision protects certain incentives to enrollees (including waiver of coinsurance and deductible amounts) paid by health care plans. The second new provision protects certain negotiated price reduction agreements between health care plans and contract health care providers. Finally, an existing safe harbor has been amended to protect certain agreements entered into between hospitals and Medicare SELECT insurers. These safe harbors specifically set forth various standards and guidelines that, if met, will result in the particular arrangement being protected from criminal prosecution or civil sanctions under the anti-kickback provisions of the statute.

Centers for Medicare and Medicaid Services, U.S.↗