Healthcare Fraud and Abuse
Health Care Management Cluster
14 November 2011
Research Paper
U.S. Health Care and Compliance
A System Challenged By Schemes, Scams, Fraud, and Abuse
“Laws are made to restrain and punish the wicked; the wise and good do not need them as a guide, but only as a shield against rapine and oppression; they can live civilly and orderly, though there were no law in the world.” John Milton (1608-1674)
On August 31, 2010, in Los Angeles, California, the former chief executive officer of City of Angels Medical Center was sentenced to 24 months in prison for paying illegal kickbacks for referrals of patients who were recruited in downtown’s “Skid Row” district. The physician was also ordered to pay more than $4.1 million in restitution to the Medicare and Medi-Cal programs. He pleaded guilty in December 2008 to defrauding Medicare and Medi-Cal by recruiting homeless persons from the Skid Row and providing them with unnecessary health services (Examples of 1).
On September 21, 2011, David J. Easton, of Everly, Iowa, was sentenced to 42 months in prison, two years of supervised release and ordered to pay $165,170 in restitution to Medicaid and $35,616 in restitution to Coventry Health Care. Easton pleaded guilty on September 17, 2010, to health care fraud, money laundering, and aggravated identity theft charges. According to his plea agreement, Easton owned and operated Medicap pharmacy in Spencer, Iowa. He admitted that, from about 2003 to 2006, he defrauded Medicaid and Coventry Health Care out of more than $200,000 by submitting false claims for prescriptions. He used the identities and identification numbers of Medicaid patients when he submitted false prescription claims to the Medicaid program. Easton used some of the proceeds of his schemes to purchase a Cadillac Escalade (Examples of 1).
A New Orleans-based orthopedic surgeon was sentenced to one year of home confinement and ordered to pay $750,000 in restitution for
14 November 2011
Research Paper
U.S. Health Care and Compliance
A System Challenged By Schemes, Scams, Fraud, and Abuse
“Laws are made to restrain and punish the wicked; the wise and good do not need them as a guide, but only as a shield against rapine and oppression; they can live civilly and orderly, though there were no law in the world.” John Milton (1608-1674)
On August 31, 2010, in Los Angeles, California, the former chief executive officer of City of Angels Medical Center was sentenced to 24 months in prison for paying illegal kickbacks for referrals of patients who were recruited in downtown’s “Skid Row” district. The physician was also ordered to pay more than $4.1 million in restitution to the Medicare and Medi-Cal programs. He pleaded guilty in December 2008 to defrauding Medicare and Medi-Cal by recruiting homeless persons from the Skid Row and providing them with unnecessary health services (Examples of 1).
On September 21, 2011, David J. Easton, of Everly, Iowa, was sentenced to 42 months in prison, two years of supervised release and ordered to pay $165,170 in restitution to Medicaid and $35,616 in restitution to Coventry Health Care. Easton pleaded guilty on September 17, 2010, to health care fraud, money laundering, and aggravated identity theft charges. According to his plea agreement, Easton owned and operated Medicap pharmacy in Spencer, Iowa. He admitted that, from about 2003 to 2006, he defrauded Medicaid and Coventry Health Care out of more than $200,000 by submitting false claims for prescriptions. He used the identities and identification numbers of Medicaid patients when he submitted false prescription claims to the Medicaid program. Easton used some of the proceeds of his schemes to purchase a Cadillac Escalade (Examples of 1).
A New Orleans-based orthopedic surgeon was sentenced to one year of home confinement and ordered to pay $750,000 in restitution for
Cited: Barrett, M.D., Stephen. "Insurance Fraud and Abuse: A Very Serious Problem." Quackwatch.com. Quatchwatch, n.d. Web. 1 Nov. 2011. Buchbinder, Sharon Bell, and Nancy H Cassata, Donna . "Obama Using ‘Bounty Hunters’ for Healthcare Fraud." Newsmax.com . Newsmax, 9 Mar. 2010. Web. 6 Nov. 2011. "Examples of Healthcare Fraud Investigations - Fiscal Year 2011." www.irs.gov Kimbuende, Eric, Usha Ranji, Janet Lundy, and Alina Salganicoff. "U.S. Health Care Costs.” Kaiser.edu.org. Henry J. Kaiser Family Foundation." n.d. Web. 8 Nov. 2011. Kouri, Jim Kurtz, Bob. "10 Physician Fraud and Abuse Cases Making Recent Headlines." www.beckersasc.com. Becker 's ASC, 19 July 2010. Web. 1 Nov. 2011. "New York Men Convicted of Health Care Fraud in Wheelchair Scheme." www.fbi.gov Outlaw, John R.. "The Case for Compliance: Why You Need an Effective Compliance Program." PathologyOutlines.com. PSA, n.d. Web. 6 Nov. 2011. Vicchrilli, Sue Werber-Serafini, Marilyn. "How Much Fraud." Healthcare.nationaljournal.com. National Journal, 29 Nov. 2009. Web. 1 Nov. 2011. "Why Do We Need Healthcare Compliance? " healthcare compliance.us "World Health Organization Assesses the World 's Health System." WHO. World Health Organization, n.d. Web. 4 Feb. 2011.