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Park E. Can Your Medical Opinion Subject You to Criminal or Civil Liability?: Recent Federal Cases Involving Medical Opinions and False Claims. Mo Med 2019; 116:442-444. [PMID: 31911713 PMCID: PMC6913853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Emily Park
- Emily Park, JD, an associate attorney in the Jefferson City office of Husch Blackwell wrote this article. She represents a full spectrum of health care providers on regulatory and other issues. The information contained in this article should not be construed as legal advice or a legal opinion on any specific facts or circumstances. The contents are intended for general information purposes only, and readers are encouraged to consult their own attorney concerning their specific situation and specific legal questions
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Centers for Medicare & Medicaid Services (CMS), HHS. Medicare Program; Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items; Update to the Master List of Items Frequently Subject to Unnecessary Utilization. Master list deletions. Fed Regist 2018; 83:13677-9. [PMID: 29969207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This document announces the deletion of four Healthcare Common Procedure Coding System (HCPCS) codes from the Master List of Items Frequently Subject to Unnecessary Utilization that could be potentially subject to Prior Authorization as a condition of payment.
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Liu S, Wang J, Zhang L, Zhang X. Caesarean section rate and cost control effectiveness of case payment reform in the new cooperative medical scheme for delivery: evidence from Xi County, China. BMC Pregnancy Childbirth 2018; 18:66. [PMID: 29523121 PMCID: PMC5845290 DOI: 10.1186/s12884-018-1698-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 03/02/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In China, increases in both the caesarean section (CS) rates and delivery costs have raised questions regarding the reform of the medical insurance payment system. Case payment is useful for regulating the behaviour of health providers and for controlling the CS rates and excessive increases in medical expenses. New Cooperative Medical Scheme (NCMS) agencies in Xi County in Henan Province piloted a case payment reform (CPR) in delivery for inpatients. We aimed to observe the changes in the CS rates, compare the changes in delivery-related variables, and identify variables related to delivery costs before and after the CPR in Xi County. METHODS Overall, 28,314 cases were selected from the Xi County NCMS agency from 2009 to 2010 and from 2014 to 2015. One-way ANOVA and chi-square tests were used to compare the distributions of CS and vaginal delivery (VD) before and after the CPR under different indicators. We applied multivariate linear regressions for the total medical cost of the VD and CS groups and total samples to identify the relationships between medical expenses and variables. RESULTS The CS rates in Xi County increased from 26.1% to 32.5% after the CPR. The length of stay (LOS), total medical cost, and proportion of county hospitals increased in the CS and VD groups after the CPR, which had significant differences. The total medical cost in the CS and VD groups as well as the total samples was significantly influenced by inpatient age, LOS, and hospital type, and had a significant correlation with the CPR in the VD group and the total samples. CONCLUSION The CPR might fail to control the growth of unreasonable medical expenses and regulate the behaviour of providers, which possibly resulted from the unreasonable compensation standard of case payments, prolonged LOS, and the increasing proportion of county hospitals. The NCMS should modify the case payment standard of delivery to inhibit providers' motivation to render CS services. The LOS should be controlled by implementing clinical guidelines, and a reference system should be established to guide patients in choosing reasonable hospitals.
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Affiliation(s)
- Shuang Liu
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030 China
| | - Jing Wang
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030 China
- The Key Research Institute of Humanities and Social Science of Hubei Province, Huazhong University of Science and Technology, Wuhan, Hubei 430030 China
| | - Liang Zhang
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030 China
| | - Xiang Zhang
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030 China
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Hughes R. With a Worthless Services Hammer, Everything Looks Like a Nail: Litigating Quality of Care Under the False Claims Act. J Leg Med 2017; 37:65-104. [PMID: 28910219 DOI: 10.1080/01947648.2016.1161569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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McCarthy M. US senators urge FDA to take action over wasted cancer drugs. BMJ 2016; 353:i3021. [PMID: 27229895 DOI: 10.1136/bmj.i3021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Krishnan V. Delhi hospitals are told not to turn away patients with suspected dengue fever. BMJ 2015; 351:h4994. [PMID: 26384376 DOI: 10.1136/bmj.h4994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Schwarzenbrunner T. [Prescribed drugs - a new crime field?]. Psychiatr Danub 2014; 26:364-367. [PMID: 25377373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The first chapter of the following article discusses measures in terms of substitution treatment of a program of the Austrian Minister of the Interior. The relevance of psychosocial measures and aims of substitution treatment for opioid-dependent patients is illuminated. The abstinence as the only goal definition is modified and by the results of the study PREMOS a target differentiation at addiction work is illustrated. The second chapter addresses the misuse of prescribed drugs. Thereby police report data will be analyzed and the market situation of opioids will be outlined.
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Affiliation(s)
- Joseph Bernstein
- Department of Orthopaedic Surgery, University of Pennsylvania, 424 Stemmler Hall, Philadelphia, PA, 19104, USA,
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Swetz KM, Burkle CM, Berge KH, Lanier WL. Ten common questions (and their answers) on medical futility. Mayo Clin Proc 2014; 89:943-59. [PMID: 24726213 DOI: 10.1016/j.mayocp.2014.02.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 02/07/2014] [Accepted: 02/12/2014] [Indexed: 12/25/2022]
Abstract
The term medical futility is frequently used when discussing complex clinical scenarios and throughout the medical, legal, and ethics literature. However, we propose that health care professionals and others often use this term inaccurately and imprecisely, without fully appreciating the powerful, often visceral, response that the term can evoke. This article introduces and answers 10 common questions regarding medical futility in an effort to define, clarify, and explore the implications of the term. We discuss multiple domains related to futility, including the biological, ethical, legal, societal, and financial considerations that have a bearing on definitions and actions. Finally, we encourage empathetic communication among clinicians, patients, and families and emphasize how dialogue that seeks an understanding of multiple points of view is critically important in preventing or attenuating conflict among the involved parties.
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Affiliation(s)
- Keith M Swetz
- Department of Medicine, Section of Palliative Medicine and Biomedical Ethics Program, Mayo Clinic, Rochester, MN.
| | | | - Keith H Berge
- Department of Anesthesiology, Mayo Clinic, Rochester, MN
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Carlson J. Whistle-blower replay. Doc turns to court in kickback case. Mod Healthc 2013; 43:18. [PMID: 24044233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Bell H. Stopping doctor-shoppers. Minn Med 2013; 96:16-19. [PMID: 23930462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Carlson J. Unclear terms. 'Unnecessary' use of stents can be hard to prove. Mod Healthc 2013; 43:14. [PMID: 23390698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Steiner DJ. Emergency care. Issue brief. Issue Brief Health Policy Track Serv 2012:1-40. [PMID: 23297453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Nippert RP, Schmidtke J. [Quality of genetic services--analysis of medical genetic expert opinions solicited by private health insurance companies]. Z Evid Fortbild Qual Gesundhwes 2012; 106:217-223. [PMID: 22682419 DOI: 10.1016/j.zefq.2011.07.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Revised: 05/23/2011] [Accepted: 07/14/2011] [Indexed: 06/01/2023]
Abstract
Service quality for patients with genetic conditions can be assessed through the analysis of clinical genetic data sets, as was the case in this study. It represents a secondary analysis of a compilation of a single genetic expert's medical opinions covering the years 2000 to 2009, solicited by private health insurance companies with the intention of probing into medical necessity and adequacy of genetic testing ordered by physicians. Genetic testing has become an increasingly important part of clinical diagnostic services. Controlling these services does not only reduce costs but also saves patients from unwarranted over-utilisation. Therefore, the reasons given by doctors when ordering genetic tests are part of the quality of service delivery. The study revealed that more than 30% of the molecular genetic tests ordered lack sound medical reasoning and 30% of the cases studied show violation or neglect of guidelines and recommendations for diagnostic procedures with respect to genetic testing. In essence, the findings indicate a need for human genetic information among physicians. Their professional organisations are called upon to design and offer CME/CPD programmes in medical genetics to maintain and continually improve the quality of medical genetic care for patients with genetic conditions.
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Affiliation(s)
- Reinhardt Peter Nippert
- Frauengesundheitsforschung, Medizinische Fakultät, Westfälische Wilhelms-Universität Münster, Münster.
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Steiner DJ. Emergency care. Issue Brief Health Policy Track Serv 2012:1-38. [PMID: 22408845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Porada S. REMS; red tape, or a remedy for opioid abuse? J Fam Pract 2011; 60:S55-S62. [PMID: 22442761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Stephen Porada
- VP REMS Communications and Project Development, Aventine Co., Montclair, NJ, USA
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Carter A. Fighting an unexpected threat to hospice care: Medicare fraud and abuse. Home Healthc Nurse 2011; 29:197-198. [PMID: 21368632 DOI: 10.1097/nhh.0b013e31820ba68b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Andy Carter
- Visiting Nurse Associations of America (VNAA), Washington, DC, USA.
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Health Policy Tracking Service, A Service of Thomson Reuters/West. Emergency care. Issue brief. Issue Brief Health Policy Track Serv 2011;:1-34. [PMID: 21370543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Markenson AJ, Evans SB. Don't forget the exclusion lists. Provider 2010; 36:43-45. [PMID: 21197914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Ari J Markenson
- Benesch, Friedlander, Coplan, & Aronoff, White Plains, NY, USA.
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Lubell J. RAC for all. Push for more audits could affect hospitals: experts. Mod Healthc 2010; 40:8-9. [PMID: 20380040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Behrens MA, Schaecher C. RAND Institute for Civil Justice report on the abuse of medical diagnostic practices in mass tort litigation: lessons learned from the 'phantom' silica epidemic that may deter litigation screening abuse. Albany Law Rev 2010; 73:521-539. [PMID: 20535882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Iglehart JK. The Baucus bill and the hope for reform. N Engl J Med 2009; 361:e36. [PMID: 19828524 DOI: 10.1056/nejmp0909696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Metnick CV. The jurisdictional bar provision: who is an appropriate relator? Ann Health Law 2008; 17:101-33, table of contents. [PMID: 18365651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
After explaining the role of the qui tam litigation and demonstrating its importance to fighting Medicare fraud and abuse, this article provides a detailed explanation of various court interpretations of the jurisdictional bar provision of the False Claims Act, a common and contentious statutory pitfall for qui tam litigators. The author provides a thorough evaluation of the law among different circuits to assist litigators in choosing favorable jurisdictions to increase their likelihood of success.
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Chananie SJ, Gulick SL. Compliance Programs: Serious Business for Health Care Providers. J Am Coll Radiol 2007; 4:214-6. [PMID: 17412270 DOI: 10.1016/j.jacr.2007.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2007] [Indexed: 11/27/2022]
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Whitaker GV, Walton VA. Recent developments in false claims enforcement: a minefield for health care providers. J Health Care Finance 2007; 33:17-21. [PMID: 19175229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Actions under the False Claims Act represent potentially billions of dollars in damages returned to the state and federal governments each year for fraud recovery. Over the past several years, health care providers have been the target of about half of the FCA suits filed and have paid out an even greater percentage of the damages recovered. Because of the enumerable opportunities for fraud, waste, and abuse in the health care industry, it will likely continue to be a prominent target of FCA suits. Key provisions of the Deficit Reduction Act of 2005, effective on January 1, 2007, will only increase the reach of the FCA. Providers beware.
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Abstract
CONTEXT Health care fraud and abuse enforcement actions have significantly expanded in number and scope during the past several years. The Department of Health and Human Services Office of Inspector General named review of in-office pathology services a critical priority in its 2005 Work Plan. As providers of pathology and laboratory medicine services, pathologists need to be aware of the potential impact of these laws on their practices. OBJECTIVES To review the major statutes and regulations underlying most federal investigations and prosecutions of health care fraud, with a special emphasis on their relationships to pathology practice. DESIGN The authors reviewed pertinent federal statutes, regulations, and other documents, along with relevant legal literature. RESULTS The health care fraud and abuse laws are complicated and potentially impact pathology practice in unforeseen ways. CONCLUSIONS The health care fraud and abuse laws are complex and often counterintuitive. The penalties for violation of these laws are severe. Because they may impact many areas of pathology and laboratory medicine practice, pathologists are advised to consult experienced legal counsel prior to embarking on potentially suspect health care arrangements.
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Affiliation(s)
- Roger D Klein
- Department of Laboratory Medicine, Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn. 06510, USA.
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Jacobsson L. [Psychiatry in society's service. Obvious abuse when mentally ill criminals are sentenced to forensic psychiatric care]. Lakartidningen 2006; 103:1822-3. [PMID: 16838593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
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Ottosson JO, Asgård U. [Use and misuse of psychiatry. Historical examples are scary...but still occur in Sweden]. Lakartidningen 2006; 103:1844, 1846-7. [PMID: 16838596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
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Health and Human Services--Office of Inspector General studies find misuse of Modifiers 59, 25. Optometry 2006; 77:195-7. [PMID: 16622943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
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Gunn J. Abuse of psychiatry. Crim Behav Ment Health 2006; 16:77-86. [PMID: 16755525 DOI: 10.1002/cbm.624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Affiliation(s)
- John Gunn
- Institute of Psychiatry, King's College, London, UK.
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Krause JH. Ethical lawyering in the gray areas: health care fraud and abuse. J Law Med Ethics 2006; 34:121-5. [PMID: 16489992 DOI: 10.1111/j.1748-720x.2006.00016.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Few areas of health law practice present as many quandaries for the ethical health lawyer as health care fraud and abuse. The activities addressed by the anti-fraud laws – such as payment for referrals and submission of false claims – not only have a direct impact on the financial viability of the federal health care programs, but go to the heart of the ethical behaviors expected of those who transact business with the government. The severe consequences of violating these proscriptions include significant monetary penalties, ineligibility to participate in the federal health care programs, and even imprisonment. It is no wonder, then, that compliance with the fraud and abuse laws is a key consideration in any health care venture. At the same time, ethical considerations make this area of health law particularly vexing for counsel, raising numerous challenges that include how to balance the strategic goals of current clients against the interests of future clients and whether to advise clients to self-report potential violations even when illegal intent may not easily be shown.
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Affiliation(s)
- Joan H Krause
- University of Houston Law Center and Health Law & Policy Institute, Houston, TX, USA.
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Fredricks T. Doctors' dilemma: prescription pain medications. J Am Osteopath Assoc 2005; 105:493-5. [PMID: 16368910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
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Young D. Senate tackles Medicaid fraud and abuse. Am J Health Syst Pharm 2005; 62:1537, 1540, 1542. [PMID: 16030357 DOI: 10.2146/news050010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Glater JD. In a surgery capital, a swirl of fraud charges. N Y Times Web 2005:BU1, BU4. [PMID: 16060017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
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Schmidt K. [A shock for 348 colleagues. Penalties up to 400,000 euro]. MMW Fortschr Med 2005; 147:40-2. [PMID: 15977633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
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Taylor M. Transporting trouble. Ambulance contracts give Fla. system a rough ride. Mod Healthc 2005; 35:38-9. [PMID: 15856827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
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Satiani B. Invited commentary: The whistle-blower act (qui tam). Surgery 2005; 137:472-6. [PMID: 15800497 DOI: 10.1016/j.surg.2004.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Bhagwan Satiani
- Division of Vascular Surgery, Department of Surgery, Ohio State University College of Medicine, 1654 Upham Drive, Columbus, OH 43210-1250, USA.
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Abstract
Some individuals in the health care system base their actions primarily on individual economic incentives rather than ethical and societal standards. These actions are considered fraudulent when they can be proven to have violated specific laws or statutes and can impact workers' compensation costs. Physicians and other health care providers involved in the management of workers' compensation claims may have little ability to affect employer or insurer fraud. Ethical and efficient practice style, in conjunction with the maintenance of clarity and objectivity in the evaluation of patient symptoms, can help to reduce the degree to which provider and patient fraud is allowed to develop and flourish. In understanding the factors that promote fraudulent behavior and being able to recognize and manage such behavior, health care providers may impact the perpetuation of fraud and its impact on the workers' compensation system.
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Affiliation(s)
- Angela Hackenschmidt
- Emergency Department, University of California-San Francisco Medical Center, San Francisco, Calif, USA.
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Hospital secures injunction to discharge patient. Wyckoff Heights Medical Center v. Rodriguez. Hosp Law Newsl 2003; 20:5-6. [PMID: 14564790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
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Abstract
Since the mid-1990s ten states have enacted statutes that have created tort liability for patient harm caused by managed care organizations, and similar liability has been considered in Congress. This study is the first attempt to evaluate the impact of these state statutes on liability exposure and litigation activity. These statutes have resulted in little or no litigation and are not seen as creating any fundamentally new type of liability exposure. This muted effect is not attributable primarily to ERISA preemption but, rather, to the costs and complexities of suing a health plan, which deter lawyers from including this additional defendant in medical malpractice cases. The main drivers of increased liability concerns are the large class-action lawsuits that are pending under federal law and the few state cases with massive punitive-damage verdicts prior to these statutes. This suggests that a federal liability statute is not likely to greatly increase liability exposure unless it allows such suits.
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Affiliation(s)
- Mark A Hall
- Wake Forest University, Winston-Salem, North Carolina, USA
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Abstract
Before the recent pharmaceutical reform in Korea that mandates the separation of drug prescribing and dispensing, physicians and pharmacists both prescribed and dispensed drugs, resulting in the overuse and misuse of drugs. The pharmaceutical reform attempts to change the provider's economic incentives by eliminating the providers' profit from drugs that have been a major source of their income. It also influences the pharmaceutical industry that has thrived on offering high margins to physicians rather than on producing high-quality drugs. However, physician strikes forced the government to modify some critical elements of the reform package and to raise medical fees substantially to compensate for the income loss of physicians. Lack of a strategic plan of implementation, failure to appreciate the change in the paradigm of health policy process, and failure to convince consumers of the benefits of the reform, are the major reasons that the historic reform of the separation of drug prescribing and dispensing has resulted in greater social cost than expected.
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Affiliation(s)
- Soonman Kwon
- Department of Health Policy and Management, School of Public Health, Seoul National University, 28 Yonkon-dong, Chongno-gu, Seoul 110-799, Republic of Korea.
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Higginbotham E. The misuse of psychotropics in the elderly. RN 2003; 66:67-8. [PMID: 12677881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
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