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Essay / Research Paper Abstract
The 1990s into the new century have seen a cleanup of Medicare fraud and abuse through various case law filed under the False Claims Act (FCA) 31 U.S.C. Section 3729 et seq., and subsequent passage of privacy acts. Two of these cases were U.S. v. Barry Weinbaum, et al. and U.S. ex rel. James F. Alderson v. Columbia/HCA. Bibliography lists 6 sources. jvMedFra.rtf
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filed under the False Claims Act (FCA) 31 U.S.C. Section 3729 et seq., and subsequent passage of privacy acts. Two of these cases were U.S. v. Barry Weinbaum, et al.
and U.S. ex rel. James F. Alderson v. Columbia/HCA. In November 2001, Tenet Healthcare, a for-profit hospital chain was audited by the U.S.
Dept. of Health and Human Services because its Medicare billing was high; and the Federal Bureau of Investigation launched an investigation of a Tenet hospital in Redding, California and two
of its cardiac surgeons for performing unnecessary heart surgeries. (Cook, 2002, 22). Columbia/HCA was also the subject of a Department of Justice investigation
during the 1990s, on allegations that it defrauded Medicare by listing items in its cost reports for expenses Medicare did not cover. In 1997, HCA pleaded guilty and paid $840
million in fines and penalties. (Cook, 2002, 23). The student may want to mention the opposition because these cases have been interpreted by
the medical industry as a form of persecution. In response to an early case, U.S. ex rel. John Schilling v. Columbia/HCA, a group of medical colleges filed suit (Assn. of
American Medical Colleges, American Medical Assn. et al. v. United States), which alleged the government is conducting illegal Medicare audits of teaching hospitals under the FCA to coerce settlements. Both
the district court and the appeal court found the case was filed prematurely. As Medicare fraud and abuse directly affect taxpayers, case law
has led to the passage of various privacy acts through the years, which give power to the government to look into the private practices of individuals. The last of these
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