The Federal Inspector General for Health and Human Services performs the vital function of preventing (when it is feasible) and finding (when it has occurred) health care fraud and abuse. The OIG is involved in bringing order and justice to the system. Because health care comprises about 17% of our gross domestic product, the potential financial reward for fraud is enormous and the opportunity for individuals and organized criminal groups to steal from the citizens of the United States is substantial.
The OIG's Green Book "sets forth various projects to be addressed during the fiscal year by the Office of Audit Services, Office of Evaluation and Inspections, Office of Investigations, and Office of Counsel to the Inspector General."
If you are health care provider, health care attorney, administrator, financial advisor or involved in payment for health care services, the Green Book is an important read. And if you plan to make your living by defrauding our government, taxpayers, those who pay health care bills, the Green Book sends a clear warning: our government goes after cheaters.
Showing posts with label Fraud and Abuse. Show all posts
Showing posts with label Fraud and Abuse. Show all posts
Wednesday, October 5, 2011
Wednesday, March 17, 2010
Hype: Fraud and Abuse Enforcement Will Have A Major Impact on Health Care Costs
Health care fraud and abuse enforcement will yield major program savings only if there is a cultural change among errant health care providers which leads them to believe that they shouldn't steal health care dollars.
Why should we believe that federal fraud and abuse investigation and prosecution will yield major savings under health care reform? My experience as a health care attorney was that federal attorneys would focus on a case only if there was an opportunity to recover a large sum relatively quickly for the government. They were not interested in spending their energy and government resources unless there was a significant return on the dollars invested in investigation and prosecution. Until federal attorneys' promotions, recommendations and career evaluations include consideration of their success in changing the culture which fosters fraudulent activities, rather than just how much money they rake in for the government, they will have no major incentive to attack the low level operators who do not seem to pose much of a threat to our society, but in total, bleed enormous sums from our health care system.
Why should we believe that federal fraud and abuse investigation and prosecution will yield major savings under health care reform? My experience as a health care attorney was that federal attorneys would focus on a case only if there was an opportunity to recover a large sum relatively quickly for the government. They were not interested in spending their energy and government resources unless there was a significant return on the dollars invested in investigation and prosecution. Until federal attorneys' promotions, recommendations and career evaluations include consideration of their success in changing the culture which fosters fraudulent activities, rather than just how much money they rake in for the government, they will have no major incentive to attack the low level operators who do not seem to pose much of a threat to our society, but in total, bleed enormous sums from our health care system.
Friday, October 9, 2009
Is Something Rotten In Canada's Health IT Stimulus Program
See Dana Blankenhorn's report which begins:"The scandal involves charges of influence peddling regarding the 2007 award of a health IT contract to Pixalere Healthcare, now called Web Med Technology, for wireless diagnostic software." Pouring billions into our health system's electronic records and allied systems will open another door to health care fraud in America which may make predictions of cost-savings ludicrous..
Thursday, August 13, 2009
Health Insurers' Wish Lists
Like children, hoping for a rewarding visit from Santa Claus in December, Health Insurers have their own wishes, waiting to be granted. While kids want Santa to come with a full sack of goodies, the insurers might want (and have already negotiated for) an empty sack from Congress and President Obama. Read on -
1. No weakening of anti-trust protection of insurers for the their activities constituting the "business of insurance."
2. No meddling by the federal government in the salaries and bonuses of health insurance company executives and their key staff.
3. No action by the federal government which might draw major employers away from traditional health care insurers to an insurance pool or public plan.
4. No interference by the federal government with health insurers' drug distributing subsidiaries ability to extract rebates, discounts and other incentives from pharmaceutical companies, as well as providers of other health care goods and services, and not pass them on to patients and employers.
5. No entry by the federal government into administration of health plan enrollments and premium collection and distribution which would cut into health insurers' profitable administrative overhead revenues.
6. No extension of federal fraud and abuse laws to the products, services and arrangements provided by insurers, their subsidiaries and contracting parties.
7. No national standard uniform contract for health care insurers with patients, employers and other similarly interested parties.
8. No single payer system.
9. No federal requirement of freedom of access by all health insurers to all physicians, nurses, hospitals and other organization which provide health care services (see #11).
11. No American standard of enforceable performance by health insurers for the services and products they sell to employers and patients, and no weakening of the ERISA protection of insurers against private lawsuits by injured patients and their families.
12. No restriction on the ability of health care insurers to purchase networks of providers and facilities who will then provide services only to each owner-insurers' clientele.
13. No unionization of health care professionals, such as physicians.
14. No interference with the system by which 50 states regulate insurers.
15. No restriction on commercial "free speech" by health insurers.
10. (Inadvert. omitted - added 8/17/09) - No requirement that the insurance companies be required to provide high-technology prostheses.
1. No weakening of anti-trust protection of insurers for the their activities constituting the "business of insurance."
2. No meddling by the federal government in the salaries and bonuses of health insurance company executives and their key staff.
3. No action by the federal government which might draw major employers away from traditional health care insurers to an insurance pool or public plan.
4. No interference by the federal government with health insurers' drug distributing subsidiaries ability to extract rebates, discounts and other incentives from pharmaceutical companies, as well as providers of other health care goods and services, and not pass them on to patients and employers.
5. No entry by the federal government into administration of health plan enrollments and premium collection and distribution which would cut into health insurers' profitable administrative overhead revenues.
6. No extension of federal fraud and abuse laws to the products, services and arrangements provided by insurers, their subsidiaries and contracting parties.
7. No national standard uniform contract for health care insurers with patients, employers and other similarly interested parties.
8. No single payer system.
9. No federal requirement of freedom of access by all health insurers to all physicians, nurses, hospitals and other organization which provide health care services (see #11).
11. No American standard of enforceable performance by health insurers for the services and products they sell to employers and patients, and no weakening of the ERISA protection of insurers against private lawsuits by injured patients and their families.
12. No restriction on the ability of health care insurers to purchase networks of providers and facilities who will then provide services only to each owner-insurers' clientele.
13. No unionization of health care professionals, such as physicians.
14. No interference with the system by which 50 states regulate insurers.
15. No restriction on commercial "free speech" by health insurers.
10. (Inadvert. omitted - added 8/17/09) - No requirement that the insurance companies be required to provide high-technology prostheses.
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