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White Collar Crime by Health Care Providers Pamela H
NORTH CAROLINA LAW REVIEW Volume 67 | Number 4 Article 7 4-1-1989 Fraud by Fright: White Collar Crime by Health Care Providers Pamela H. Bucy Follow this and additional works at: http://scholarship.law.unc.edu/nclr Part of the Law Commons Recommended Citation Pamela H. Bucy, Fraud by Fright: White Collar Crime by Health Care Providers, 67 N.C. L. Rev. 855 (1989). Available at: http://scholarship.law.unc.edu/nclr/vol67/iss4/7 This Article is brought to you for free and open access by Carolina Law Scholarship Repository. It has been accepted for inclusion in North Carolina Law Review by an authorized administrator of Carolina Law Scholarship Repository. For more information, please contact [email protected]. FRAUD BY FRIGHT: WHITE COLLAR CRIME BY HEALTH CARE PROVIDERSt PAMELA H. Bucyt Fraudby health care providers is one of the most deleterious of all white collar crimes. It is also one of the most difficult to prosecute. In her Article, ProfessorBucy comparesfraud by health care providers with other types of white collar crime and analyzes the theories offraud his- torically used to prosecute health careproviders. She concludes that the strongest theory--prosecutionfor providing unnecessary or substandard health care-is the theory that has been used the least. ProfessorBucy suggests ways for prosecutors to use this theory more often and more effectively in order to combat a problem that ravishes human dignity and personal health as well as the nationalpocketbook "I will apply measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice." Portion of Oath of Hippocrates, Sixth Century B.C.- First Century A.D.; currently administered by many medical schools to graduating medical students.1 "[I c]ould make a million dollars out of the suckers ..... -
Fostering Innovation to Fight Waste, Fraud, and Abuse in Health Care
FOSTERING INNOVATION TO FIGHT WASTE, FRAUD, AND ABUSE IN HEALTH CARE HEARING BEFORE THE SUBCOMMITTEE ON HEALTH OF THE COMMITTEE ON ENERGY AND COMMERCE HOUSE OF REPRESENTATIVES ONE HUNDRED THIRTEENTH CONGRESS FIRST SESSION FEBRUARY 27, 2013 Serial No. 113–10 ( Printed for the use of the Committee on Energy and Commerce energycommerce.house.gov U.S. GOVERNMENT PRINTING OFFICE 80–160 WASHINGTON : 2013 For sale by the Superintendent of Documents, U.S. Government Printing Office Internet: bookstore.gpo.gov Phone: toll free (866) 512–1800; DC area (202) 512–1800 Fax: (202) 512–2104 Mail: Stop IDCC, Washington, DC 20402–0001 VerDate Nov 24 2008 12:32 May 15, 2013 Jkt 037690 PO 00000 Frm 00001 Fmt 5011 Sfmt 5011 F:\MY DOCS\HEARINGS 113\113-10 CHRIS COMMITTEE ON ENERGY AND COMMERCE FRED UPTON, Michigan Chairman RALPH M. HALL, Texas HENRY A. WAXMAN, California JOE BARTON, Texas Ranking Member Chairman Emeritus JOHN D. DINGELL, Michigan ED WHITFIELD, Kentucky Chairman Emeritus JOHN SHIMKUS, Illinois EDWARD J. MARKEY, Massachusetts JOSEPH R. PITTS, Pennsylvania FRANK PALLONE, JR., New Jersey GREG WALDEN, Oregon BOBBY L. RUSH, Illinois LEE TERRY, Nebraska ANNA G. ESHOO, California MIKE ROGERS, Michigan ELIOT L. ENGEL, New York TIM MURPHY, Pennsylvania GENE GREEN, Texas MICHAEL C. BURGESS, Texas DIANA DEGETTE, Colorado MARSHA BLACKBURN, Tennessee LOIS CAPPS, California Vice Chairman MICHAEL F. DOYLE, Pennsylvania PHIL GINGREY, Georgia JANICE D. SCHAKOWSKY, Illinois STEVE SCALISE, Louisiana ANTHONY D. WEINER, New York ROBERT E. LATTA, Ohio JIM MATHESON, Utah CATHY MCMORRIS RODGERS, Washington G.K. BUTTERFIELD, North Carolina GREGG HARPER, Mississippi JOHN BARROW, Georgia LEONARD LANCE, New Jersey DORIS O. -
Medicare Fraud and Improper Billing
Medicare Fraud and Improper Billing ISSUE BRIEF • July 2018 Part I. Medicare Fraud Prevention Micki Nozaki, Director, California Health Advocates, Senior Medicare Patrol California Health Advocates Founded in 1997, California Health Advocates (CHA) is the leading Medicare advocacy and education non-profit in California. We advocate on behalf of Medicare beneficiaries and their families; conduct public policy research to support improved rights and protections for Medicare beneficiaries; and provide accurate and up-to-date Medicare information for both Medicare beneficiaries and their families as well as the advocates and providers who serve them. Senior Medicare Patrol The California Senior Medicare Patrol (SMP) is a project under CHA. We empower and assist Medicare beneficiaries, their families, and caregivers to prevent, detect, and report healthcare fraud, errors and abuse through: (1) Education: SMPs give presentations to groups, exhibit at events and work one-on-one with Medicare beneficiaries; (2) Counseling: SMPs work to protect older adults’ health, finances and medical identity while saving precious Medicare dollars; and (3) Assisting Medicare beneficiaries, caregivers and family members when they bring their concerns or complaints to the SMP. We determine whether fraud, errors, or abuse are suspected. When fraud or abuse is assumed, we make referrals to the appropriate state and federal agencies for further investigation. There are 54 Senior Medicare Patrol (SMP) programs throughout the country. SMPs are grant-funded projects of the federal U.S. Department of Health and Human Services, Administration for Community Living. Key Lessons 1. The Medicare Trust Fund loses $60–$90 billion every year to fraud, errors, and abuse.Although the exact figure is impossible to measure, the U.S. -
Healthcare Fraud & Abuse Review 2017
HEALTHCARE FRAUD & ABUSE REVIEW 2017 i | BASS, BERRY & SIMS HEALTHCARE FRAUD & ABUSE REVIEW 2017 1. A LOOK BACK…A LOOK AHEAD 4. NOTEWORTHY SETTLEMENTS 7. ISSUES TO WATCH 12. FALSE CLAIMS ACT UPDATE 37. STARK LAW/ANTI-KICKBACK STATUTE 40. PHARMACEUTICAL AND MEDICAL DEVICE DEVELOPMENTS 42. APPENDIX – 2017 NOTABLE SETTLEMENTS Hospitals and Health Systems Managed Care/Insurance Hospice Laboratory, Pathology, Radiology and Diagnostics Home Health Specialty Care and Other Provider Entities SNFs and Nursing Homes Individual Providers Pharmaceutical and Device Miscellaneous/Non-Providers Pharmacy Services 70. ABOUT BASS, BERRY & SIMS General (HHS-OIG), along with federal and state law enforcement entities, including 30 Medicaid Fraud Control Units, charged more than 400 defendants, including 115 healthcare professionals, A LOOK BACK… in 41 federal districts for allegedly participating in fraudulent healthcare arrangements resulting in over $1.3 billion in false claims.6 A LOOK AHEAD Occurring in the context of combatting the opioid crisis, the takedown focused on individuals allegedly involved in fraudulent billing of Medicare, Medicaid and TRICARE for medically While the uncertainty associated with legislative efforts to repeal unnecessary prescription and compounded drugs that were not actually purchased or distributed to patients covered by a federal healthcare program. In total, more than 120 the Patient Protection and Affordable Care Act (PPACA) dominated defendants, including physicians, were charged in connection with prescribing and distributing most of the headlines for the healthcare industry last year, it was opioids and narcotics. Nearly 300 individuals—including physicians, nurses and pharmacists— mostly business as usual for the government’s healthcare fraud received exclusion notices from HHS-OIG barring future participation in federal healthcare 7 enforcement efforts. -
September 6, 2019 the Honorable Lindsey Graham the Honorable
1701 K STREET, N.W., SUITE 950 • WASHINGTON, D.C. 20006 • PHONE: 202.331.1616 • WWW.BRETTONWOODS.ORG September 6, 2019 The Honorable Lindsey Graham The Honorable Patrick Leahy Chairman Ranking Member State, Foreign Operations, and Related Programs State, Foreign Operations, and Related Programs Committee on Appropriations Committee on Appropriations United States Senate United States Senate Dear Senator Graham and Senator Leahy: We write to ask that you support both the authorization and appropriations for the general capital increase (GCI) for the International Bank for Reconstruction and Development (IBRD) and the International Finance Corporation (IFC) of the World Bank Group. As you know, the World Bank Group’s shareholders endorsed an ambitious package of measures for the capital increase in 2018. It includes internal reforms and a set of policy measures that greatly strengthens the institution’s ability to scale up resources and deliver on its mission of fighting global poverty. It was developed in response to an increasingly complex development landscape and to confront emerging challenges to the global economy which will require a coordinated and sustained effort. The Bank has also developed, for the first time, a comprehensive strategy to address fragility, conflict and violence in countries where assistance is needed the most. It is important that the United States supports this effort because it: • Promotes National Security Interests World Bank support to countries where poverty and disease can breed political instability and foster extremism is vital to U.S. national security interests. World Bank projects promote stability in weak states and help mitigate cross-border problems – such as the Ebola outbreak and refugee crises – which precipitates positive spillover effects on national, regional, and global security fostering a safer world for all Americans. -
Smithsonian Institution 2015 Annual Report
Now+Next Smithsonian Institution / 2015 Annual Report The National Museum of African American History and Culture will open to the public Sept. 24, 2016. table of contents 2 Secretary’s Letter photo 4 2015 Milestones 6 Art Now+Next 14 Science Now+Next 22 History & Culture Now+Next 30 Education & Outreach Now+Next 40 Donors to the Smithsonian Wynton Marsalis performs at the Installation ceremony for 13th Secretary of the Smithsonian David J. Skorton. Now+Next Few events in my life have been as uplifting and humbling as that of Oct. 19, 2015, the day I was honored to become the 13th Secretary of the Smithsonian Institution. The Installation ceremony began with a procession of the institution’s scholars, curators and scientists, representing not only the more than 6,000 staff who dedicate themselves to the Smithsonian’s mission today, but also the many thousands more who have advanced the fields of history, art and science since the institution’s founding in 1846. In 2015 alone we welcomed hundreds of thousands of people to the newly renovated Renwick Gallery (p. 6), our scientists peered to the edge of the black hole at the center of the Milky Way (p. 18) and our anthropologists helped identify the remains of leaders of the Jamestown colony (p. 28). The theme of this year’s annual report is “Now+Next” because the work we do today leads to the innovations of tomorrow. Thanks to the support of many generous private donations, Congress and the American people, we will continue to increase our understanding of the world, and to share that understanding with you. -
Covid Fraud Tracker
Subject name(s) Date Law Enforcement Alleged Conduct Summary Relevant statute(s) State Court Type of Action Individual subject? Corporate subject? Follow-on action? Matter Number Dates of unlawful Penalties Press Release Petition/ Agreement/J Announced Agency conduct (civil/criminal fines, Complaint/ udgment incarceration) Indictment Grubhub Holdings Inc. 7/29/2021 Massachusetts AG Consumer fraud Grubhub Holdings Inc. is accused of violating a provision of Massachusetts's economic G. L. c. 93A Massachusetts D. Mass. Civil No Yes No https://www.mas development legislation, which prohibited Grubhub and other third party delivery service enforcement s.gov/news/ag- platforms from charging fees to restaurants that exceed 15 percent of an order's menu healey-sues- price. The fee cap came into effect on January 14, 2021 and remained in place until grubhub-for- Governor Baker lifted the state of emergency in Massachusetts on June 15, 2021. charging- restaurants- illegally-high-fees- during-covid-19- public-health- emergency Dinesh Sah 7/28/2021 USDOJ PPP fraud Dinesh Sah pleaded guilty to wire-fraud and money laundering for submitting 15 fraudulent 18 U.S.C. §§ 1343, 1957 Texas W.D. Tex. Criminal Yes No No 3:20-cr-00484 Incarceration; https://www.justi applications that sought $24.8 million in Paycheck Protection Program ("PPP") loans. Sah enforcement Restitution ce.gov/opa/pr/te filed the claims under the names of various businesses that he owned or controlled, xas-man- claiming these businesses had numerous employees and hundreds of thousands of dollars sentenced-24- in payroll expenses; in reality, no business had employees or paid wages consistent with the million-covid-19- amounts claimed in the PPP applications. -
Protecting Yourself & Medicare from Fraud
CENTERS for MEDICARE & MEDICAID SERVICES Protecting Yourself & Medicare from Fraud This booklet explains: ■ How to protect yourself and Medicare from fraud ■ How to identify and report billing errors and concerns ■ What to do if you suspect Medicare fraud ■ How to protect your personal information Table of contents 4 Introduction 5 How to spot & report Medicare fraud 10 Protect yourself from identity theft 10 Protect yourself when dealing with private companies who offer Medicare plans 13 Additional fraud resources 14 Tips to help prevent Medicare fraud The information in this booklet describes the Medicare program at the time this booklet was printed. Changes may occur after printing. Visit Medicare.gov, or call 1-800-MEDICARE (1-800-633-4227) to get the most current information. TTY users should call 1-877-486-2048. 3 Introduction Most doctors, health care providers, suppliers, and private companies who work with Medicare are honest, however, some aren’t. Individuals, companies, or groups can commit fraud. One example of Medicare fraud is when Medicare is billed for services or supplies that you never got. Medicare fraud wastes a lot of money each year. Fraud results in higher health care costs and taxes for everyone. Medicare is working to find and prevent fraud and abuse. We’re working more closely with health care providers and improving the way we review Medicare claims for possible billing fraud. Read this booklet to learn how you can help fight and protect yourself from fraud. 4 How to spot & report Medicare fraud Protect yourself and Medicare against fraud by reviewing your Medicare claims for errors, looking for other types of fraud, and reporting anything suspicious to Medicare. -
RESPONDING to CHALLENGES in MEDICAL DEVICE SECURITY? Tara Larson
RESPONDING TO CHALLENGES IN MEDICAL DEVICE SECURITY? Tara Larson - Chief Security Architect CRHF Medtronic 10-May- 2015 HOMELAND SEASON 2, EPISODE 10 – “BROKEN HEARTS” HYPOTHESIZED PACEMAKER HACK Challenge: Hypothesized “hack”: . Bad guy breaks into the Vice President’s home . Finds VP’s remote monitor . Provides the home monitor serial number to a remote hacker . Hacker remotely and wirelessly adjusts a pacemaker setting using monitor serial number . VP is killed instantly from ventricular fibrillation Let’s talk about reality and then get back to this one. 2016 MEDEC Regulatory Conference DESIGN FOR SECURITY CHALLENGES . Agenda: . What is the problem? . How do we solve the challenge? . Design for Security . How is medical device security different for IT security? . How are Medical Device Manufacturers Assessing product risk? . How do Medical Device Manufacturers ensure security for product lifecycle? 2016 MEDEC Regulatory Conference MEDICAL DEVICE SECURITY PROBLEMS .Protection of therapy systems and services including data from unauthorized modification, destruction or disclosure that can lead to patient harm or loss of customer trust. Protection controls often only present the opportunity to secure at time of manufacturing. Often the device must live inside a human body for the life of the battery. 2016 MEDEC Regulatory Conference CHALLENGES IN MEDICAL DEVICE SECURITY . Security engineering principles . IT Security practices are hard to apply to Medical Devices . Product Security risk assessment . Must be tied to safety and include business risks . Generating actionable & testable cybersecurity requirements . Security Requirements are not positive , hard to test a negative . Understanding Threat Models . Threat models must encompass Common Vulnerability and Product threats . Security risk mitigations from industry applied to medical devices . -
Arizona Human Trafficking Council June 2, 2021, 9:00 AM Virtual
Arizona Human Trafficking Council June 2, 2021, 9:00 AM Virtual Meeting 1700 West Washington Street, PHOENIX, ARIZONA 85007 A general meeting of the Arizona Human Trafficking Council was convened on June 2, 2021 virtually, 1700 West Washington Street, Phoenix, Arizona 85007, notice having been duly given. Members Present (21) Members Absent (5) Cindy McCain, Co-Chair David Curry Maria Cristina Fuentes, Co-Chair Marsha Calhoun Brian Steele Rachel Mitchell Cara Christ Lois Lucas Debbie Johnson Nathaniel Brown Dominique Roe-Sepowitz Doug Coleman Tony Mapp (Proxy for Heston Silbert) Jennifer Crawford Jill Rable Dave Saflar (Proxy for James Gallagher) Jim Waring Joseph Kelroy Jeramia Ramadan (Proxy for Michael Wisehart) Mike Faust Sarah Beaumont Sarah Kent Sheila Polk Tim Roemer Zora Manjencich Heather Carter Staff and Guests Present (9) Kim Brooks Nick Lien Vianney Careaga Nick Alamshaw Claire Merkel Mike Russo Joanna Jauregui Anastasia Stinchfield Julia Martin Arizona Human Trafficking Council 06/02/2021 Meeting Minutes Page 2 of 7 Call to Order ● Mrs. Cindy McCain, Co-Chair, called the Arizona Human Trafficking Council meeting to order at 9:01 a.m. with 21 members and 9 staff and guests present. Roll Call ● Director Maria Cristina Fuentes, Co-Chair, welcomed Director Tim Roemer, Arizona Department of Homeland Security, as the newest member of the Council. Prior to this change in leadership, Director Roemer served as Arizona’s Chief Information Security Officer. With his appointment to Homeland Security, the cyber security operations overseen by Director Roemer at Arizona Department of Administration has shifted to Homeland Security, allowing the state to better protect citizens from cybersecurity attacks. -
Administration of Barack Obama, 2013 Digest of Other White House
Administration of Barack Obama, 2013 Digest of Other White House Announcements December 31, 2013 The following list includes the President's public schedule and other items of general interest announced by the Office of the Press Secretary and not included elsewhere in this Compilation. January 1 In the evening, the President traveled to Honolulu, HI, arriving the following morning. The White House announced that the President will travel to Honolulu, HI, in the evening. January 2 In the morning, upon arrival at Joint Base Pearl Harbor–Hickam, HI, the President traveled to Kailua, HI, where he had separate telephone conversations with Gov. Christopher J. Christie of New Jersey and Gov. Andrew M. Cuomo of New York to discuss Congressional action on the Hurricane Sandy supplemental request. In the afternoon, the President signed H.R. 8, the American Taxpayer Relief Act of 2012. During the day, the President had an intelligence briefing. He also signed H.R. 4310, the National Defense Authorization Act for Fiscal Year 2013. January 3 In the morning, the President had a telephone conversation with House Republican Leader Eric Cantor and House Democratic Leader Nancy Pelosi to extend his welcome to all Members of the 113th Congress. In the afternoon, the President had a telephone conversation with Speaker of the House of Representatives John A. Boehner and House Democratic Leader Nancy Pelosi to congratulate them on being redesignated to lead their respective parties in the House. During the day, the President had an intelligence briefing. The President announced the designation of the following individuals as members of a Presidential delegation to attend the Inauguration of John Dramani Mahama as President of Ghana on January 7: Daniel W. -
God Overcomes Our Broken Hearts | Outrageous #4
God Overcomes Our Broken Hearts | Outrageous #4 www.pursuegod.org /god-overcomes-our-broken-hearts-outrageous-4/ Heartbreak Is an Inescapable Part of Life The Bible provides many examples of the heartaches common in life. For example, Hannah was heartbroken because of infertility. 1 Samuel 1:10 “Hannah was in deep anguish, crying bitterly as she prayed to the Lord.” King David experienced heartbreak over the death of his son. 2 Samuel 18:33 The king was overcome with emotion. He went up to the room over the gateway and burst into tears. And as he went, he cried, ‘O my son Absalom! My son, my son Absalom! If only I had died instead of you! O Absalom, my son, my son.” The prophet Jeremiah lived through the destruction of his homeland by invasion. Lamentations 2:11 I have cried until the tears no longer come; my heart is broken. My spirit is poured out in agony as I see the desperate plight of my people. Even Jesus was not exempt from heartbreak. Isaiah 53:3 He was despised and rejected – a man of sorrows, acquainted with deepest grief. God Will Restore All Our Losses God will turn our fortunes around – but it might not happen the way you expect. For example, it may or may not happen in this life. God eventually gave Hannah a son. But David and Jeremiah lived with their losses for the rest of their lives. But if not in this life, God’s restoration will happen in the life to come. One day all things will be made new.