Health Care Fraud: Hearing Before the Committee on the Judiciary, United States Senate, One Hundred Third Congress, Second Session, on Examining Federal, State, and Local Efforts to Combat Fraud and Abuse in the Health Care Industry and Related Provisions of the Proposed Health Security Act, May 25, 1994, Volume 4 |
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Common terms and phrases
activities Administration agencies AHCCCS Attorney authority beneficiaries CHAIRMAN civil monetary penalties CONGRESS THE LIBRARY convicted costs criminal defraud delivery system Department of Justice doctors dollars durable medical equipment efforts entities facilities False Claims Act Federal Government federal health fees forfeiture fraud and abuse Fraud Control Units fraud enforcement Fraud Unit fraudulent funding going health care delivery health care fraud health care offense health care programs health care providers health care reform health care system health plan Health Security Act hospital Inspector investigate and prosecute involved kickbacks law enforcement legislation LIBRARY OF CONGRESS MANGANO Medicaid Fraud Control Medicaid programs Medicare and Medicaid ment MFCUS million National Health NHCAA nursing home patient abuse payment percent physicians private insurance private payers private sector problem proposal provider fraud qui tam refer reimbursement RESS schemes self-referral Senator Cohen statute tion violations WATERBURY
Popular passages
Page 90 - A physician shall deal honestly with patients and colleagues, and strive to expose those physicians deficient in character or competence, or who engage in fraud or deception.
Page 88 - August 21, 1996, under Federal or State law, in connection with the delivery of a health care item or service...
Page 123 - ... operated by or financed in whole or in part by any Federal, State, or local government agency...
Page 22 - Act, and false statements statutes to prosecute health care fraud and abuse. There are also criminal statutes directed specifically to prevent fraud and abuse within Federal health care programs. Such authorities include criminal penalties for false claims and statements specifically involving the Medicare and Medicaid programs, and the Medicare and Medicaid anti-kickback statute. The anti-kickback statute prohibits an individual or entity from offering, paying, soliciting, or receiving remuneration...
Page 86 - General shall establish a program — (A) to coordinate Federal, State, and local law enforcement programs to control fraud and abuse with respect to health plans, (B) to conduct investigations, audits, evaluations, and inspections relating to the delivery of and payment for health care in the United States...
Page 100 - In general, physicians should not refer patients to a health care facility which is outside their office practice and at which they do not directly provide care or services when they have an investment interest in that facility.
Page 89 - Physicians may invest in and refer to an outside facility, whether or not they provide direct care or services at the facility, if there is a demonstrated need in the community for the facility and alternative financing is not available.
Page 92 - Investigation to discuss issues relating to fraud and abuse. Throughout this very constructive session, FBI representatives made it clear that physicians are not responsible for the vast majority of health care fraud and abuse. The AMA, however, does not take comfort from the fact that the number of physicians who seek to gain through fraudulent practices is...
Page 20 - There are several categories of fraud which we have seen in HHA operations: cost report fraud; excessive services or services not rendered; use of unlicensed or untrained staff; falsified plans of care and forged physician's signatures; kickbacks; and intermediary hopping. Since 1986, we have concluded 24 successful criminal prosecutions of HHAs and their employees.
Page 101 - Self-referral cannot be justified simply if the facility would offer some marginal improvement over the quality of services in the community. The potential benefits of the facility should be substantial to justify assuming the risks of self-referral.