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Essay / Research Paper Abstract
A 6 page paper answering 3 questions about laws governing Medicare fraud (Stark, RICO) and the value of having a formal compliance plan. Bibliography lists 4 sources.
Page Count:
6 pages (~225 words per page)
File: CC6_KSmedicFraud.rtf
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Unformatted sample text from the term paper:
own words of a provider upcoding for higher reimbursement, if any, give the statutes, regulations, or other principles In the early 1990s, Park
Medical Center in Columbus, Ohio conducted a "Senior Treatment Enrichment Program" to provide psychiatric services to older adults. The patients were mostly residents of local nursing homes and were
transported to the hospital to take part in the program. On its surface, Park Medicals program appeared to be a beneficial one, but the center consistently billed Medicare and
Medicaid for 20 therapy sessions each week for each participant, averaging nearly three sessions per patient daily if sessions were held seven days a week. Closer inspection revealed that
the activities undertaken during these group therapy sessions were not psychiatric in their focus, but rather more for entertainment purposes. Psychiatric services are
covered by Medicare and Medicaid; adult daycare is not (Kelton, n.d.). The U.S. Attorneys office for the Southern District of Ohio conducted a two-year investigation of Park Medicals billing
practices; the final outcome was that Park Medical agreed to pay $1.45 million to settle the investigation and escape criminal charges of massive Medicare and Medicaid fraud.
This is one of the largest settlements reached in the many similar cases that have come under review. Aside from the fraud involved, the great
pity is that Park Medical had hired a contractor, Quorum, to conduct the program. Shortly after agreeing to pay the large settlement, Park Medical immediately filed suit against Quorum
in an effort to recover the funds. It appears that Quorum intended to defraud, but it was Park Medicals lack of any type of coordinated guidelines effort that allowed
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