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Healthcare Qui Tam - Term Paper Example

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Research institutions and hospitals collect billions of dollars per annum in state and federal grants for research, as well as other specialized endeavors, in the health care sector. Principally, these grants have firm parameters within which the funds can be spent, and just for the objectives set forth and permitted in the grant…
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Healthcare Qui Tam
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In Virginia, many hospitals were billing for outpatient procedures with codes kept for physician’s office visits rather than an outpatient procedure performed at the health center. Medicare pays a high rate for physician’s office appointments to mirror the cost of their operating cost (Warren & Benson Group, 2009). Hospitals obtain a separate facilities fee to settle the overhead cost. Therefore, the correct repayment rates for hospital outpatient services are lesser. The hospitals agreed to a payment of $3 million.
A Pennsylvania hospital settled on paying a $2.7 million defrayal due to its upcoding fraud. The center was submitting claims for a multifaceted form of pneumonia when the accurate diagnosis showed a simpler form, which is compensated at a lower rate. The hospital decided to pay $500,000 for other upcodings with counterfeit claims for septicemia (Warren & Benson Group, 2009).
A Florida hospital decided to pay $2,531,000 for issuing false claims for laser procedures executed as part of post cataract elimination surgery by demonstrating that the procedures were executed after the 39-day post-operative phase. It is also issued claims for actions, which were either never upcoded or rendered. Finally, they issued claims for two management services and evaluations per patient visit.
Finally, a Hawaii doctor agreed to recompense a $2.1 million settlement for issuing false claims to Medicaid. The doctor operated a pharmacy in his hospital. The doctor billed Medicaid for providing expensive drugs when the clinic issued cheaper generic substitutes (Warren & Benson Group, 2009). ...
A Florida hospital decided to pay $2,531,000 for issuing false claims for laser procedures executed as part of post cataract elimination surgery by demonstrating that the procedures were executed after the 39-day post-operative phase. It is also issued claims for actions, which were either never upcoded or rendered. Finally, they issued claims for two management services and evaluations per patient visit. Finally, a Hawaii doctor agreed to recompense a $2.1 million settlement for issuing false claims to Medicaid. The doctor operated a pharmacy in his hospital. The doctor billed Medicaid for providing expensive drugs when the clinic issued cheaper generic substitutes (Warren & Benson Group, 2009). Question 3 The following procedure could be used to admit a patient to a hospital, which upholds the law about the required number of Medicare and Medicaid referrals. Permission letter always should be issued before the admission of the person in the hospital (McCarty, 2008). The patient should be given Pre-requisite permission for a medical procedure and not for general consultations. The beneficiary will be urged to furnish a photocopy of a valid CGHS card, a request letter from CGHS, or a photocopy of the specialist’s professional advice. After that, then the patient will be offered an admission memo. In case of a therapeutic emergency, the hospital accepted under CGHS, shall not refuse or deny admission or demand early deposit from the concerned patient. Nevertheless, the hospital accepted under CGHS, shall offer credit facilities to the respective patient on issuing of a valid CGHS card (McCarty, 2008). Rooted in the virtues of the case study on an ...Download file to see next pagesRead More
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