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At least 163 records · Page 9Linked to original sources
PubMed2001

Avoiding Medicare fraud. Part 2.

In 1997, Congress authorized payments to nurse practitioners (NPs) for Medicare-provided services. NP services are now reimbursed at 85% of the physician fee schedule. As this source of reimbursement was realized, so was a new area of liability for NPs. Failure to follow billing rules can result in payment denial, repayment of fees already paid, mandated educational activities, fines, fraud prosecution, loss of Medicare-billing ability, and loss of employment. Appropriate billing entails adhering to guidelines for selecting procedure codes and proper medical documentation. This article identifies high-risk areas for NPs who bill Medicare and provides resources for accessing additional information.

Documentation↗
PubMed2001

Government cracks down on billing fraud.

As the largest professional caregiving group, nurses have a stake in preventing misuse of the reimbursement system. Technology also plays a crucial role, as automated billing systems can both prevent and enable billing fraud.

Fraud↗
PubMed1985

Fraud and abuse of government medical benefit programs by psychiatrists.

Government rosters of physicians suspended from the Medicare and Medicaid programs because of fraud and abuse indicate that psychiatrists form a disproportionately large segment of the total. Of the factors contributing to this situation, the most notable is that because psychiatrists charge for time rather than for services, they are more readily apprehended if they violate the rules. The authors speculate on whether in fact psychiatrists break the law more than physicians in other-specialties or whether the statistics are purely artifactual.

Crime↗
PubMed1990

Techniques for defending health care fraud and abuse cases.

The successful defense of a health care fraud and abuse case requires the early initiation of an aggressive, pro-active approach. In this article, the author describes various techniques for establishing client relations, assessing the case, developing a favorable defense, and avoiding exclusionary sanctions.

Crime↗
PubMed1990

Crime at the top: detecting and preventing fraud, theft, and embezzlement.

Perhaps the most financially damaging scenario a hospital can face is when its chief executive officers (CEOs)--presidents and top financial directors--engage in fraud, theft, and embezzlement. Not only are these crimes often impossible to detect, they usually involve dollar amounts in the millions. So harmful is top-level crime to the reputation of a hospital that, all too often, it remains covered up and goes unprosecuted. In this report, we will present several criminal cases and offer advice on practical steps you can take to ensure that such crimes do not occur at your hospital. We will also discuss proactive measures a security department can employ to become involved in investigating crime at the top.

Crime↗
PubMed1990

Fighting Medicare and Medicaid fraud and abuse.

The Department of Health and Human Services' inspector general has become more aggressive in recent years in ferreting out cases of fraud and abuse against the Medicare and Medicaid programs. Where will this "watchdog" focus future efforts?

Fraud↗
PubMedDate not supplied

Fraud and abuse: the payer's perspective.

As the health care sector consumes an ever-increasing portion of our nation's gross national product (GNP)), forecast to represent 15 percent of the GNP by the year 2000, increasingly intensive efforts are being used to control the growth rate of these costs. Medicare fraud alone is estimated to represent $2 billion yearly. Abusive billing of private health insurers represents a far larger amount. This article discusses the concept of fraudulent and abusive physician billing practices.

Abstracting and Indexing↗
PubMed1992

Health care programs: fraud and abuse; amendments to OIG exclusion and CMP authorities resulting from Public Law 100-93--HHS. Final rule.

This final rule implements the OIG sanction and civil money penalty provisions established through section 2 and other conforming amendments in the Medicare and Medicaid Patient and Program Protection Act of 1987, along with certain additional provisions contained in the Consolidated Omnibus Budget Reconciliation Act of 1985, the Omnibus Budget Reconciliation Act (OBRA) of 1987, the Medicare Catastrophic Coverage Act of 1988, OBRA of 1989, and OBRA of 1990. Specifically, these regulations are designed to protect program beneficiaries from unfit health care practitioners, and otherwise to improve the anti-fraud provisions of the Department's health care programs under titles V, XVIII, XIX and XX of the Social Security Act.

Civil Rights↗
PubMed1992

Economic credentialing and the fraud and abuse caveat.

Courts often uphold hospital credentialing decisions based in part on economic criteria. Nonetheless, as this article discusses, arrangements where medical staff privileges or other benefits appear to be offered to physicians as an incentive to refer patients may be suspect under the Medicare/Medicaid fraud and abuse law.

Antitrust Laws↗
PubMed1993

Medicare and state health care programs: fraud and abuse; amendments to OIG exclusion and CMP authorities resulting from the Medicare and Medicaid Patient and Program Protection Act--Office of Inspector General (OIG), HHS. Final rule.

This document amends a technical error that appeared in the final rule, which amends the OIG exclusion and CMP authorities, published on January 29, 1992 designed to implement section 2 of the Medicare and Medicaid Patient and Program Protection Act, along with other conforming amendments. The final rule is designed to protect program beneficiaries from unfit health care practitioners, and otherwise improve the anti-fraud provisions of the Department's Medicare and State health care programs.

Fraud↗
PubMed1993

A team approach to fraud prevention.

The author discusses the importance of a fraud prevention program and why a team approach--auditor plus security loss prevention manager--works in the healthcare industry.

Financial Audit↗
PubMed1994

Special report. PBX and voice mail fraud: what it is and how to protect against it.

As automation technology advances, so does the savvy of the criminal mind. And because the human factor is becoming more and more removed from costly operations such as telecommunications, scammers are even more difficult to track--in most cases leaving nothing but anonymous dial tones for clues. In this report, we will examine two types of telecommunications theft--PBX and voice mail fraud--as well as other scams capable of bilking thousands of dollars from hospital telecommunications budgets.

Fraud↗
PubMed1994

Fraud & abuse in managed care--what does it mean for home care providers?

Managed care and home care are both increasingly popular as market and regulatory forces push payors and providers to reduce costs. The reform initiatives that have given rise to the increase in both these services, however, have also increased scrutiny of fraud and abuse. What do home care providers need to be aware of to protect themselves?

Fraud↗
PubMed1992

The impact of fraud and abuse regulations.

Increased forays by hospitals and physicians into joint ventures make both parties subject to a complex network of laws and regulations and to scrutiny by many Federal agencies. In this article, the law of fraud and abuse under the Federal Medicare and Medicaid statutes is discussed.

Contract Services↗
PubMed1995

Preventing fraud and abuse fallout.

With government and public scrutiny of healthcare costs becoming more intense, the healthcare industry can learn from the defense industry's response to charges of fraud, waste, and abuse. Ethics-awareness programs, compliance programs, and related training can reduce the risks of such violations and their financial and public relations consequences.

Ethics, Institutional↗