Question

Do a quick web search and find an example of a recent (within the last 5 years) fraud and abuse allegation in the healthcare industry.  Summarize the situation (in your own words). Identify which fraud and abuse law is at issue in the case (false claims act, anti-kickback statue, Stark laws) and explain why.

Cite your source.

Answer 1

Fraud and abuse allegations in the healthcare industry are :-

1. Tuomey hospital stark law violation guilty verdict - they violated the stark act by providing kickback to physician in return for referral patient to the hospitals of their known too.

2. City of Angels Medicare- They violated the false claim act and anti kickback statutes by paying kickback to recruiters employed at los Angeles homeless shelter to delivery homeless patient by ambulance to hospital and used to charge huge for theedicare which was not necessary also and which were not provided to the patient.

3. Kyphoplasty related false claim allegations settlement -many hospitals were conducting kyphoplasty as a inpatient procedure just to increase the bill of the patient as the procedure is a minimal invasive procedure done to treat spinal fractures .

4. Christiana care whisleblower kickback claim settlement - in this the Medicare used to pay rewards as a kickback statutes to the neurologist for referring patient to their hospital at Wilmington.

5. Robert wood Johnson University Hospital Hamilton - it used to fasle inflate the charges to patients for the services so that the hospital can obtain higher reimbursement from federal programs.

In the above mentioned 1st,2nd and 4th points , stark law and anti kickback law is violated because the patients are referred to other hospital / Medicare services because the physician has a financial relationship with that entity .

In the 3rd ad 5th points, the medicare /health industry has knowingly violated the federal programs( defraud the government programs) by increasing the charges of procedure and conducting unnecessary procedures which are not required for the patient.

Souce :-

http:// www.whistleblower.org

http:// the law dictionary .org

http:// en.m Wikipedia .org

http:// stark law.org

http:// www.beckershospitalreview.com

http :// ncbi.nlm.nih.gov