Question

32. Patients with Alzheimer’s diseases sat, twice every week, unsupervised inside a small room of a memory care facility watching the movie Forrest Gum. Each time the patients sat in front of the television watching the movie, the facility submitted insurance claims for providing “group therapy.” Is this practice legal and appropriate , or is it an example of health care fraud.

Answer 1

Health care fraud is a type of white collar crime that involves the filling of dishonest Heath care claims in order to turn a profit.

Group therapy is a form of psychotherapy that involves one or more therapists working with several people at the same time, as mentioned in the question the patients were unsupervised, therefore above mentioned situation is not a group therapy but a false claim, and this practice is not legal & appropriate and is an example of health care fraud

A similar case of health care fraud was seen on Oct. 21, 2010 when a federal government strike force charged that Alzheimer's and dementia patients living in Miami assisted-living facilities were exploited in a fraud that netted an estimated $200 million in bogus Medicarepayments.