Health Insurance Fraud

Paper Summary:

This paper critically evaluates the statutes purposely passed to tackle Medicare and Medicaid insurance fraud. It evaluates the fundamentals, penalties, defenses, and safe harbor provisions for each and every statute, and concludes with a discussion of accessible legal safe harbor provisions. It discusses the wide-ranging federal statutes employed to impeach health care fraud, together with the False Claims, False Statements, and Mail and Wire Fraud Acts and explains the basics of the offenses, accessible defenses, and penalties valid under each statute. It also gives an indication of federal and state government agencies' pains to examine and take legal action against health care fraud.

Outline
Introduction
Statutes and Provisions Specifically Enacted to Address Medicare and Medicaid Fraud
Sale of Physician Practices, Practitioner Recruitment and Obstetrical Malpractice Insurance Subsidies
Contracts for Space, Equipment, Personal Services and Employment
Advertisements and Promotions
Referral Services
Relationships Between Providers
Arrangements Between Providers and Health Plans
Relationships Between Providers and Suppliers
Prosecuting Health Care Fraud with General Federal Statutes
Conclusion

From the Paper:

"Individuals and organizations licensed by Department of Health and Human Services ("HHS") to accept imbursement under the Social Security Act may focus on Medicare and Medicaid fraud examinations (7). Persons, as well as organizations comprise nursing and rehabilitation centers, hospitals, Health Maintenance Organizations ("HMOs"), intermediate carriers for example private and public clinics, private insurance companies, durable medical equipment ("DME") providers, medical laboratories, physician practice groups, physicians, as well as other certified health care organizations (7)."

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