Health Care Fraud

Since 1983 Hospice has been a Medicare benefit for individuals suffering with terminal conditions who have less than six months to live. In theory, the Medicare benefit allows patients to spend their last few months at home receiving comfort care until their death instead of enduring costly end-of-life care in a hospital setting. The program should have saved the government money while allowing patients to die with dignity in their own homes.

Healthcare fraud is rampant in the United States, costing the government billions of dollars each year. This type of fraud has deleterious effects on the average American taxpayer, causing healthcare costs to rise and fewer people to be able to get the healthcare they need.

There is a lot of waste in government-run programs generally, and a lot of waste and fraud and misuse of money in Medicare and Medicaid that can be saved. - Chuck Grassley

The Privacy Rule of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) established a national standard for the protection of certain health information.

The Stark Act, 42 USC Section 1395, includes a number of exceptions to the prohibition to the ownership and compensation arrangement described in my recent post.

What is the Stark Law?

Congress enacted the Stark Law as part of the Omnibus Budget Reconciliation Act of 1989. The Stark Law, 42 USC Section 1395nn, also referred to as the Physician Self–Referral Law, has certain prohibitions when a physician or member of his or her immediate family has a direct or indirect financial arrangement or relationship with an entity:

(1) First, the physician may not make a referral to an entity that provides certain designated health services covered by the Medicare program or any other federal heathcare payor program; and

The Federal Government and several major health insurers have recently announced a partnership that will take unprecedented steps to eviscerate fraud from the health care industry.  The two sides will share raw data, as well as investigative knowledge and expertise, as they aim to shut off billions of dollars in questionable payments made by the health care system each year.

While insurance companies grudgingly adhere to the requirements of President Barack Obama’s health care overhaul law, industry leaders point out that combating fraud remains atop the list of priorities.