Medicare Fraud & Abuse by Majolie Callan: Secondary sources

  HEALTH CARE FRAUD 49 Am. Crim. L. Rev. 863 (Spring, 2012):The federal government concentrates on detecting and prosecuting health care fraud in its health care insurance programs, Medicare and Medicaid. Statutes enacted to deal with fraud in these specific programs are necessary because, “[a]s the government's second largest social program, Medicare continues to be an attractive target for fraud and abuse.”  

FRAUD BUSTERS 33-OCT L.A. Law. 29 (2010):   The Federal Bureau of Investigation and the National Health Care Anti-Fraud Association estimate that 3 to 10 percent of our national healthcare spending is lost to fraud and abuse. With healthcare spending at $2.5 trillion in 2009 and growing, it is estimated that $75 to $250 billion is lost each year to fraud and abuse. These losses dwarf the highly successful enforcement efforts by the U.S. Department of Justice (DOJ) and U.S. Department of Health and Human Services (HHS).    

 WHAT EXACTLY IS HEALTHCARE FRAUD AFTER THE AFFORDABLE CARE ACT?       42 Stetson L. Rev. 35  (Fall, 2012): This Article attempts to outline the major changes in fraud and abuse law made by the Affordable Care Act. Importantly, the Article seeks not merely to report on the Act's changes to fraud  law, but rather to set the changes in the context of their respective statutes' purposes and policy goals, particularly as those purposes and policy goals affect healthcare providers.  

THE FALSE CLAIMS ACT AND THE ERODING SCIENTER IN HEALTHCARE FRAUD LITIGATION 20 Annals Health L. 49 (Winer, 2012): This paper addresses the federal government's expansive methods in tackling healthcare fraud, particularly in misapplying the FCA. Although tasked with the obligation of curtailing fraudulent submissions of Medicare and Medicaid claims, the U.S. government must also rein in the current trend of using the FCA against smaller medical providers.

OPTIMIZING QUI TAM LITIGATION AND MINIMIZING FRAUD AND ABUSE: A COMMENT ON CHRISTOPHER ALEXION'S OPEN THE DOOR, NOT THE FLOODGATES 69 Wash. & Lee L. Rev. 419 (Winter, 2012). One of the primary weapons in the federal government's health care fraud armamentarium is the civil False Claims Act (FCA). A key feature of the FCA is its qui tam provision, the focus of Christopher Alexion's Note. The qui tam provision allows a person with special knowledge of a fraud to sue on behalf of the government and to keep part of the recovery.The qui tam provisions of the statute, however, raise a central problem: When does a qui tam claimant provide sufficiently valuable information that the claimant should be granted a share of the recovery?

TURNING UP THE HEAT: HEALTH CARE COMPLIANCE AND ENFORCEMENT IN THE CLIMATE OF HEALTH CARE REFORM 14 No. 2 J. Health Care Compliance 37 (March-April, 2012). Health care reform and related government initiatives have raised the stakes for compliance issues, including the increased possibility of criminal actions and personal risk for key leadership.  Entities must act quickly in the event of a suspicion of a Medicarebilling problem to meet the new sixty-day refund provisions imposed by PPACA. Failure to refund in a timely fashion could provide grounds for allegations under the False Claims Act. In the event of an investigation, the entity must understand the legal requirements associated with the allegations and any related guidance, and be prepared to educate the investigators. Ongoing compliance monitoring can help ensure that inevitable errors and systemic problems are caught before becoming major issues.

    RETHINKING FRAUD REGULATION BY RETHINKING THE HEALTH CARE SYSTEM   32 Hamline J. Pub. L. & Pol'y 411(Spring, 2011). Will greater use of cost and quality measures in reimbursement and regulation eliminate fraud? No. The creativity of individuals intent on committing fraud is boundless. Continued commitment to  *427 fraud and abuse enforcement is essential to ensure that quality measurement, quality reporting, and value-based purchasing programs function properly.

West's ALR Digest

Federal Criminal Prosecution Against Medical Practitioner for Fraud in Connection with Claims Under Medicaid, Medicare, or Similar Welfare Program Providing Medical Services 66 A.L.R. Fed. 2d 1.

State Criminal Prosecution Against Medical Practitioner for Fraud in Connection with Claims Under Medicaid, Medicare, or Similar Welfare Program for Providing Medical Services 79 A.L.R.6th 125

Increase in base offense level under sentencing guidelines § 3B1.3 (U.S.S.G. § 3B1.3) for abuse of position of public or private trust significantly facilitating commission or concealment of offense 121 A.L.R. Fed. 323

Illegal remuneration under Medicare anti–kickback statute (Social Security Act § 1128B) (42 U.S.C.A. §§ 1320a-7b) 132 A.L.R. Fed. 601

Florida Jurisprudence 2d. (Florida Jur. 2d)

§ 242, § 182, & § 5

American Jurisprudence 2d. (Am. Jur. 2d)

§ 99 & §100

§  2325. Medicare payment when items are under warranty

§  2326. Obligation to pay for ambulance services

Corpus Juris Secundum (C.J.S.)

§ 235. Purpose; construction of provisions.