Healthcare Fraud and Penalties

Healthcare Fraud and Penalties

NOTE: Cite at least 2 scholarly references published within the last 2 years, and one reference must be the course textbook, Chapters 4,5 & 6. All sources should be cited using APA format 7th edition.

Primary Task Response: Within the Discussion Board area, write 400–600 words that respond to the following questions with your thoughts, ideas, and comments. This will be the foundation for future discussions by your classmates. Be substantive and clear, and use examples to reinforce your ideas.

Federal agencies are increasingly becoming active in investigating violations of healthcare laws. In addition, private lawsuits are surfacing from violations of healthcare laws. Find a recent case where there has been a violation of a healthcare law, such as a case involving any of the following:

• Fraud
• Privacy
• Security

Then, discuss your responses to the following questions:

• What tort or criminal law was violated?
• Who was the investigating agency?
• Were there civil or criminal penalties? What were the penalties?
• In your opinion, was this a fair penalty for the violation that occurred?

(SEE ATTACHMENT FOR COURSE TEXTBOOK)

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APA

Healthcare Fraud and Penalties

In recent years, healthcare fraud has become a major area of focus for both federal agencies and private litigants. One such case that highlights this issue involves the case of United States v. AseraCare, a healthcare provider accused of submitting false claims for Medicare reimbursement. AseraCare was accused of falsely certifying that patients were eligible for hospice care when they were not terminally ill, thus fraudulently billing Medicare for services rendered to non-terminal patients. The case resulted in significant penalties and highlighted the growing concern over healthcare fraud.

Tort or Criminal Law Violated

In this case, the violation primarily involved fraud, which is a criminal offense under the False Claims Act (FCA). The FCA imposes liability on individuals and companies that knowingly submit false claims to the government for payment. By submitting false claims to Medicare for non-qualifying patients, AseraCare violated both federal fraud statutes and the False Claims Act. This is a significant issue because it involves taxpayers’ funds and the integrity of…