Health Care Crime And Regulatory Control
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Health Care Crime And Regulatory Control
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Author : Russell G. Smith
language : en
Publisher: Hawkins Press
Release Date : 1998
Health Care Crime And Regulatory Control written by Russell G. Smith and has been published by Hawkins Press this book supported file pdf, txt, epub, kindle and other format this book has been release on 1998 with Family & Relationships categories.
Published with the Australian Institute of Criminology.Medicine has always been intimately involved with crime and criminology, whether it is through explanations of criminal behaviour or the attempt to modify this behaviour through treatment. This book looks at the interaction between the criminal justice system and regulating health care practice. Covering a variety of disciplines, the books addresses regulatory controls and the regulation in health care of alternative health care methods, sexual misconduct in health care, unlawful killing and fraud.
Crime In The Professions
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Author : Russell G Smith
language : en
Publisher: Routledge
Release Date : 2017-11-30
Crime In The Professions written by Russell G Smith and has been published by Routledge this book supported file pdf, txt, epub, kindle and other format this book has been release on 2017-11-30 with Social Science categories.
This title was first published in 2002: This text critically examines the nature and extent of crime and deviance in the professions and how it should be dealt with. Looking in particular at the crimes committed by professionals such as doctors, accountants and nurses, the book offers some innovative solutions to preventing and controlling professional crime. Containing 16 chapters written by some of Australia's leading scholars in the fields of professional regulation and crime control, the book examines the increasing professionalization of the workforce and the changes in the way in which professionals carry out their work.
Regulating Medical Work
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Author : Judy Allsop
language : en
Publisher:
Release Date : 1996
Regulating Medical Work written by Judy Allsop and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 1996 with Medical categories.
Examines the formal and informal regulations of medical work in the health service. The text explores two major issues - firstly the boundaries between state-sanctioned self regulation and other regulatory systems, secondly, the relationship between formal and informal controls.
Healthcare Crime
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Author : Kelly M. Pyrek
language : en
Publisher: CRC Press
Release Date : 2011-01-19
Healthcare Crime written by Kelly M. Pyrek and has been published by CRC Press this book supported file pdf, txt, epub, kindle and other format this book has been release on 2011-01-19 with Law categories.
Crime perpetrated by healthcare professionals is increasingly pervasive in today‘s hospitals and other healthcare settings. Patients, coworkers, and employers are vulnerable to exploitation, fraud, abuse, and even murder. Investigative journalist Kelly M. Pyrek interviews experts who provide accounts concerning the range of criminality lurking in t
License To Steal
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Author : Malcolm K Sparrow
language : en
Publisher: Hachette UK
Release Date : 2007-12-14
License To Steal written by Malcolm K Sparrow and has been published by Hachette UK this book supported file pdf, txt, epub, kindle and other format this book has been release on 2007-12-14 with Political Science categories.
Who steals? An extraordinary range of folk -- from low-life hoods who sign on as Medicare or Medicaid providers equipped with nothing more than beepers and mailboxes, to drug trafficking organizations, organized crime syndicates, and even major hospital chains. In License to Steal, Malcolm K. Sparrow shows how the industry's defenses, which focus mostly on finding and correcting billing errors, are no match for such well orchestrated attacks. The maxim for thieves simply becomes "bill your lies correctly." Provided they do that, fraud perpetrators with any degree of sophistication can steal millions of dollars with impunity, testing payment systems carefully, and then spreading fraudulent billings widely enough across patient and provider accounts to escape detection. The kinds of highly automated, quality controlled claims processing systems that pervade the industry present fraud perpetrators with their favorite kind of target: rich, fast paying, transparent, utterly predictable check printing systems, with little threat of human intervention, and with the U.S. Treasury on the end of the electronic line. Sparrow picks apart the industry's response to the government's efforts to control this problem. The provider associations (well heeled and politically influential) have vociferously opposed almost every recent enforcement initiative, creating the unfortunate public impression that the entire health care industry is against effective fraud control. A significant segment of the industry, it seems, regards fraud and abuse not as a problem, but as a lucrative enterprise worth defending. Meanwhile, it remains a perfectly commonplace experience for patients or their relatives to examine a medical bill and discover that half of it never happened, or that; likewise, if patients then complain, they discover that no one seems to care, or that no one has the resources to do anything about it. Sparrow's research suggests that the growth of capitated managed care systems does not solve the problem, as many in the industry had assumed, but merely changes its form. The managed care environment produces scams involving underutilization, and the withholding of medical care schemes that are harder to uncover and investigate, and much more dangerous to human health. Having worked extensively with federal and state officials since the appearance of his first book on this subject, Sparrow is in a unique position to evaluate recent law enforcement initiatives. He admits the "war on fraud" is at least now engaged, but it is far from won.
Deviance Among Physicians
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Author : Thaddeus L. Johnson
language : en
Publisher: Routledge
Release Date : 2019-05-15
Deviance Among Physicians written by Thaddeus L. Johnson and has been published by Routledge this book supported file pdf, txt, epub, kindle and other format this book has been release on 2019-05-15 with Social Science categories.
The concept of deviance is complex, given that norms vary considerably across groups, times, and places. Society tends to primarily recognize traditional portraits of deviants such as street-offenders and drug addicts. The label "deviant" is commonly cast upon society’s undesirables, but this socially constructed image often overlooks subtler—and arguably more dangerous—deviance. Physician malfeasance is an especially problematic form, given that medical professionals garner trust, autonomy, and prestige from society, which allows them to operate outside of the public eye. This book responds to a growing number of concerns regarding deviant physician actions such as physically and sexually abusive behaviors, fabricating medical findings and records, and taking advantage of patients (e.g., filing fraudulent Medicaid claims). It explores theoretical explanations for physician deviance, and goes on to consider potential responses such as Medicaid Fraud Control Units, the Questionable Doctors database, and the ability of doctors to police themselves. The unique perspective offered in this book informs discussions of white-collar crime and deviance and has important implications for researchers, policymakers, and students involved in criminal justice and public policy.
Regulating Healthcare
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Author : Walshe, Kieran
language : en
Publisher: McGraw-Hill Education (UK)
Release Date : 2003-06-01
Regulating Healthcare written by Walshe, Kieran and has been published by McGraw-Hill Education (UK) this book supported file pdf, txt, epub, kindle and other format this book has been release on 2003-06-01 with Education categories.
Healthcare organizations in the UK and the USA face a growing tide of regulation, accreditation, inspection and external review, all aimed at improving their performance. In the US, over three decades of regulation by state and federal government, and by non-governmental agencies, has created a complex, costly and overlapping network of oversight arrangements for healthcare organizations. In the UK, regulation of the government-run National Health Service is central to current health policy, with the creation of a host of new national agencies and inspectorates tasked with overseeing the performance of NHS hospitals and other organizations. But does regulation work? This book: . explores the development and use of healthcare regulation in both countries, comparing and contrasting their experience and drawing on regulatory research in other industries and settings . offers a structured approach to analysing what regulators do and how they work . develops principles for effective regulation, aimed at maximising the benefits of regulatory interventions and minimising their costs Regulating Healthcare is aimed at all with an interest or involvement in health policy and management, be they policy makers, healthcare managers or health professionals. It is particularly suitable for use on postgraduate health and health-related programmes.
Crime In The Home Health Care Field
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Author : Brian K. Payne
language : en
Publisher: Charles C Thomas Publisher
Release Date : 2003-01-01
Crime In The Home Health Care Field written by Brian K. Payne and has been published by Charles C Thomas Publisher this book supported file pdf, txt, epub, kindle and other format this book has been release on 2003-01-01 with Home care services categories.
Over the past couple of decades, individuals have come to rely more on home health care visits for their health care needs. While there have been decreases in hospital stays and in the percentage of older persons living in nursing homes the consequence has been the emergence of a new type of occupational crime: home health care abuse. In considering offending in the home health care industry, it is important to focus on crimes by and against home health care professionals. This book is one of the first to fully address abuses occurring in the home health care industry. Its intent is not to suggest that home health care is a dangerous field for workers and consumers; rather, the intent is to shed some light on the types of misconduct found in home health care. Each chapter will include a wealth of examples to illustrate that these incidents actually are real, devastating, and significant. At the end of each chapter the reader will find a series of discussion questions designed to encourage the reader to reflect back on the content of the chapter through the eyes of those involved in the response to home health care fraud. Also included are Web site addresses where readers can learn more about the offenses and other resources to help demonstrate ways to deal with the problem. It is intended for criminal justice officials, health care professionals, academics, and researchers who want to better understand the nature of offending in the home health care industry. It is also intended for use in criminal justice, sociology, and white-collar crime courses exploring crime in the workplace as well as courses examining the home health care field. Chapters include: Home, Home on the Range: Where Health Care is Provided and Crimes are Committed; Home Health Care Professionals as Victims and Witnesses; Crimes by Home Health Professionals: Violence, Theft, and Deception; Responding to Crime in the Home Health Care Field: Strategies, Obstacles, and Issues; and Preventing Home Health Care Misconduct.
Health Care Fraud And Abuse Compliance Manual
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Author : Aspen Health Law Center
language : en
Publisher: Aspen Pub
Release Date : 1997-01
Health Care Fraud And Abuse Compliance Manual written by Aspen Health Law Center and has been published by Aspen Pub this book supported file pdf, txt, epub, kindle and other format this book has been release on 1997-01 with Health & Fitness categories.
An immensely practical resource, Health Care Fraud and Abuse Compliance Manual provides a comprehensive overview of legislative and regulatory restrictions that affect the way health care providers conduct business and how they structure relationships among themselves. This treatise helps providers determine the boundaries of permissible conduct under the myriad statutes and regulations that relate to health care fraud and abuse at both the federal and state levels. Specific coverage includes: The statutory language in the Medicare/Medicaid civil money penalties and false claims statutes The Medicare/Medicaid antikickback statute The Stark "self-referral" law The numerous safe harbors and exceptions contained with these prohibitions And more! This authoritative resource will make you aware of your crucial obligations and options. Each chapter of the Health Care Fraud and Abuse Compliance Manual describes what the law requires, how it applies in a health care context, and what the penalties are for failure to comply. With Health Care Fraud and Abuse Compliance Manual: You'll receive coverage of all the critical laws and considerations, including: false claims and fraudulent billings, civil and criminal penalties, the antikickback statute, the safe harbor regulations, the Stark Law, and state statutes You'll get practical advice on developing a corporate compliance program that can help you stay on the right side of the law You'll learn about the structures, goals, and procedures of agencies that investigate health care fraud You'll get an in-depth understanding of what goes into a fraud and abuse investigation - and how you can respond to an investigation to best defend your organization And much, much more! Health Care Fraud and Abuse Compliance Manual has been updated to include: Updated nationwide health care fraud and abuse enforcement statistics OIG Work Plan for FY 12 (Medicaid projects) Enforcement actions involving billing for services of unlicensed personnel Enforcement actions involving billing without proper documentation Enforcement actions involving illegal inducements to beneficiaries Hospital liability for submission of false cost reports Cases involving maximum hospital liability for EMTALA violations Criminal false claims liability for unsolicited telemarketing by a DME supplier Managed care provider liability for cherry-picking, retaining overpayments, and other practices Hospice liability for providing services to ineligible patients Pharmaceutical manufacturer liability for pricing-related false claims violations Enforcement actions involving federal research grant fraud Criminal kickback liability for sham consulting arrangements Self-referral liability for office lease agreements and independent contractor relationships inconsistent with fair market value or not memorialized in writing Updated Medicaid Fraud Control Unit performance standards (MFCU) False claims laws of Massachusetts, Montana, and Nevada OIG evaluation of Massachusetts, Montana, and Nevada false claims laws
License To Steal
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Author : Malcolm K Sparrow
language : en
Publisher: Westview Press
Release Date : 1996-08-08
License To Steal written by Malcolm K Sparrow and has been published by Westview Press this book supported file pdf, txt, epub, kindle and other format this book has been release on 1996-08-08 with Health & Fitness categories.
Criminal fraud must be factored into the current debates about health care reform, budget deficits, and proposed Medicare/Medicaid cutbacks. As a polity, how can we make good public policy if we don't know how much of the nation's one trillion dollar health care budget is being lost to fraud? The amounts are staggering, measured in hundreds of billions of dollars, but nobody knows for sure exactly how much is being lost.Malcolm Sparrow, an expert on fraud control, reviews how the health care industry approaches the problem and concludes that fraud is rampant, largely uncontrolled, and mostly invisible to policymakers. The problem will only get worse, he says, unless the industry at all levels changes its priorities, its strategies for uncovering and preventing fraud, and its technological approach.Many believe that electronic claims processing will save billions of dollars and that managed care will eliminate the major categories of fraud. By contrast, Sparrow shows how electronic claims processing could lead to unprecedented fraud losses, and how managed care makes fraud much more dangerous to human health.The final section—prescriptions for progress—is a must for policymakers at every level, and for anyone with an interest in the science of fraud control more broadly, in any context.