What are some of the healthcare fraud schemes? What is a current OIG case of fraud or abuse? How can Medicare beneficiaries help to combat fraud?
Some of the healthcare fraud schemes:
Office of Inspector General (OIG) case:
The current OIG case of fraud/abuse was from District of Nevada which was announced on April 18, 2019 as on US Department of Health and Human Services official website. This is about a fraud Medicare Health scheme of $7.1million where a former medical doctor and his business partner were involved in three Las Vegas hospice and home healthcare agency services. They were sentenced to 33 months of imprisonment.
Medicare beneficiaries involvement to combat fraud:
What are some of the healthcare fraud schemes? What is a current OIG case of fraud...
On August 24, 2011, Khachatryan Yervand was indicted on charges of healthcare fraud and money laundering. Investigators believe that Yervand billed Medicare over $4.3 million for durable medical equipment that was either medically unnecessary or was never provided. Yervand owned Midvalley Medical Supply (Midvalley), a durable medical equipment company located in Van Nuys, California. Investigators believe that Yervand and his co-conspirator, former Midvalley owner George Hakopian, submitted false and fraudulent claims for motorized wheelchairs and orthotics that were not medically...
In November 2015, Ebong Aloysius Tilong was indicted on charges of conspiracy to commit healthcare fraud, healthcare fraud, conspiracy to pay kickbacks, payment of kickbacks, and conspiracy to commit money laundering. Investigators believe that Tilong and his wife Marie Neba fraudulently billed Medicare millions for home health services that were either medically unnecessary or were not provided. Tilong and Neba operated Fiango Home healthcare, Inc., a home health agency doing business in Houston, Texas. Trial evidence showed that Tilong paid...
On February 7, 2007, Betros Garabet was indicted on charges of healthcare fraud and false statements. Investigators believe that Garabet orchestrated a scheme to bill Medicare $260,842 for medically unnecessary treatments and services. According to the indictment, Garabet, who was not a licensed physician, opened several medical clinics in the Los Angeles area. Esther Foliente, a licensed physician, permitted Garabet to use her medical license to operate one of the medical clinics and bill Medicare for services rendered at that...
Discussion topic 1: Corruption Fraud Schemes According to the ACFE, corruption fraud schemes fall into four basic categories: Bribery Illegal gratuities Economic extortion Conflicts of interest A corruption fraud scheme can distort a company’s financial statements, or cause a company’s economic losses. As an auditor, you should be aware of red flags that can indicate some type of corruption, such as related party transactions. A major accounting scandal at Enron in the early 2000’s was the result of using related...
Fraud and abuse are big issues with Medicare. What area is more problematic to Medicare: fraud or abuse? Defend your choice. What is Medicare doing to alleviate this problem?
Describe your responsibility as a healthcare manager as it applies to fraud and abuse. What if you were a unit manager? A department manager? A member of the executive team?
The Office of Inspector General (OIG), which is part of the Department of Health and Human Services was established by Congress in 1976 to identify and eliminate fraud, waste, and abuse if the Department of Health and Human Services Programs (example: Medicare) and to promote efficiency and economy in department operations. This mission is carried out through a nationwide program of audits, investigations, and inspections. For medical coders whether as a hospital-based coder or as a physician-based coder, adhering do...
1. How often is the OIG work plan updated? 2. What is the purpose of the OIG work plan? 3. How does the OIG plan their work? 4. In addition to working on projects that often result in audits, reviews, and reports, OIG's work portfolio includes a number of legal and investigative activities, what are three of their legal and investigative efforts? 5. Identify and present an active OIG work plan item related to Medicare Part A, B, C or...
Find a recent case on mortgage fraud (published within the last three years) and answer the following questions: The case I have chosen is the most recent in the news for Paul Manafort. I have the background of his fraud and what he did but need some help with the rest. Thanks in advance. What is the background of the case, and how has the history of the mortgage industry led up to the current situation of the organization(s) you...
provide in 200 words Discuss the differences between fraud and abuse. And provide examples of each and explain how healthcare managers might deal with them in some kind of way.