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oapen-20.500.12657-621162024-03-27T14:14:45Z Phantom Billing, Fake Prescriptions, and the High Cost of Medicine Leap, Terry L. kickbacks, illicit referrals, overcharging and double billing, upcoding, unbundling, rent-a-patient, pill-mill schemes, insurance scams, short-pilling, off-label marketing, pharmaceuticals, rebate fraud thema EDItEUR::M Medicine and Nursing::MB Medicine: general issues::MBQ Medicolegal issues U.S. health care is a $2.5 trillion system that accounts for more than 17 percent of the nation’s GDP. It is also highly susceptible to fraud. Estimates vary, but some observers believe that as much as 10 percent of all medical billing involves some type of fraud. In 2009, New York’s Medicaid fraud office recovered $283 million and obtained 148 criminal convictions. In July 2010, the U.S. Justice Department charged nearly 100 patients, doctors, and health care executives in five states of bilking the Medicare system out of more than $251 million through false claims for services that were medically unnecessary or never provided. These cases only hint at the scope of the problem. In Phantom Billing, Fake Prescriptions, and the High Cost of Medicine, Terry L. Leap takes on medical fraud and its economic, psychological, and social costs. Illustrated throughout with dozens of specific and often fascinating cases, this book covers a wide variety of crimes: kickbacks, illicit referrals, overcharging and double billing, upcoding, unbundling, rent-a-patient and pill-mill schemes, insurance scams, short-pilling, off-label marketing of pharmaceuticals, and rebate fraud, as well as criminal acts that enable this fraud (mail and wire fraud, conspiracy, and money laundering). After assessing the effectiveness of the federal laws designed to fight health care fraud and abuse—the antikickback statute, the Stark Law, the False Claims Act, HIPAA, and the food and drug laws—Leap suggests a number of ways that health care providers, consumers, insurers, and federal and state officials can bring health care fraud and abuse under control, thereby reducing the overall cost of medical care in America. 2023-03-29T15:50:44Z 2023-03-29T15:50:44Z 2011 book ONIX_20230329_9780801460807_101 9780801460807 9780801461286 9780801449796 https://library.oapen.org/handle/20.500.12657/62116 eng application/pdf application/epub+zip Attribution-NonCommercial-NoDerivatives 4.0 International Attribution-NonCommercial-NoDerivatives 4.0 International 9780801460807.pdf 9780801461286.epub http://www.cornellpress.cornell.edu/book/9780801449796/phantom-billing-fake-prescriptions-and-the-high-cost-of-medicine Cornell University Press ILR Press 10.7298/wszs-bn07 10.7298/wszs-bn07 06a447d4-1d09-460f-8b1d-3b4b09d64407 0314e571-4102-4526-b014-3ed8f2d6750a 9780801460807 9780801461286 9780801449796 ILR Press 256 Ithaca [...] CARES National Endowment for the Humanities NEH open access
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U.S. health care is a $2.5 trillion system that accounts for more than 17 percent of the nation’s GDP. It is also highly susceptible to fraud. Estimates vary, but some observers believe that as much as 10 percent of all medical billing involves some type of fraud. In 2009, New York’s Medicaid fraud office recovered $283 million and obtained 148 criminal convictions. In July 2010, the U.S. Justice Department charged nearly 100 patients, doctors, and health care executives in five states of bilking the Medicare system out of more than $251 million through false claims for services that were medically unnecessary or never provided. These cases only hint at the scope of the problem. In Phantom Billing, Fake Prescriptions, and the High Cost of Medicine, Terry L. Leap takes on medical fraud and its economic, psychological, and social costs. Illustrated throughout with dozens of specific and often fascinating cases, this book covers a wide variety of crimes: kickbacks, illicit referrals, overcharging and double billing, upcoding, unbundling, rent-a-patient and pill-mill schemes, insurance scams, short-pilling, off-label marketing of pharmaceuticals, and rebate fraud, as well as criminal acts that enable this fraud (mail and wire fraud, conspiracy, and money laundering). After assessing the effectiveness of the federal laws designed to fight health care fraud and abuse—the antikickback statute, the Stark Law, the False Claims Act, HIPAA, and the food and drug laws—Leap suggests a number of ways that health care providers, consumers, insurers, and federal and state officials can bring health care fraud and abuse under control, thereby reducing the overall cost of medical care in America.
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