HGMT320 UMUC Medicare Fraud and Abuse Questions
Question Description
Theme 1 : Health care fraud is a form of white collar crime. It involves filing illegitimate health care claims to turn an illicit profit. The 3 major laws that protect against healthcare fraud are the Anti-kickback statute, Stark, and the False Claims Act. From the readings and independent research, find one (1) specific real life legal case example of how kickback arrangements would violate the Stark Law. In addition, discuss with your colleagues how the kickback arrangements could violate trust between provider organizations and patients. From the readings and independent research, find one (1) specific real life legal case example of a breach of the False Claims Act by a health-related organization. In addition, discuss whether health care organizations are properly equipped to ensure compliance and minimize exposure risks. If not why not?
Read the background articles. This discussion requires research beyond the articles. See Discussion Expectations and Grading for rules on discussions.
Assigned reading materials:
Medicare Fraud and Abuse: Prevention, Detention, & Reporting – https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/fraud_and_abuse.pdf
Stark and AKS Chart-http://oig.hhs.gov/compliance/provider-compliance-training/files/StarkandAKSChartHandout508.pdf
Breakdown of False Claims Act-(Control>>Click>>From Drop down Menu select Open in New Window or Copy/Paste into your URL) https://www.justice.gov/sites/default/files/civil/legacy/2011/04/22/C-FRAUDS_FCA_Primer.pdf
The Stark Truth about the Stark law Part I http://www.aafp.org/fpm/2003/1100/p27.html
Deficit Reduction Act-http://www.crowell.com/documents/docassocfktype_articles_919.pdf
Brown, J. (2008). Develop a policy for amended records. Journal of Health Care compliance, January-February, 37- 38. [must use UMUC library]
Mekel, M. (2012). The Health Care Quality Improvement Act of 1986 Meets the Era of Health Care Reform: Continuing Themes and Common Threads. Journal of Legal Medicine, (33), 106. [must use UMUC library]
Theme 2 : Respond to the question below that has been assigned to you by this Thursday and then respond to TWO of your classmates responses (in an area different than your initial response) by Sunday. Please try not to replicate other’s responses and include the topic you are responding to at the beginning of your post.
What are the characteristics of monopolistic competition? How does this differ from perfect competition?
Read:
1) Mayer Chapter 8:Imperfectly Competitive Markets
2) “The Increased Concentration”¦ Can Lead to “¦”
http://www.healthaffairs.org/doi/pdf/10.1377/hltha”¦
3) Economic Theory Through Application– 8.5 Beyond Perfect Competition pg. 334-342
4) Economic Theory Through Application – 15.1 Market Power and Monopoly pg. 652-664
5) “How Might Proposed Mergers Impact State Insurance Markets”
http://healthaffairs.org/blog/2015/12/01/how-might-proposed-payer-mergers-impact-state-insurance-markets/
6) Economic Theory Through Application – 15.3 Market with Small Number of Sellers pg. 675-693
Theme 3: Choose ONE (1) question below to discuss and then respond to TWO (2) of your classmates answers (Try not to repeat others answers). Include the question with your response.
How do charity care and bad-debt differ in both definition and how they are treated on financial statements? Explain.
What is the difference between net income and cash flow? In your discussion, include a discussion of what financial statements are used to report these measures.
What are the three types of revenue on an income statement? Explain each.
What is a non-cash expense? Provide some examples. What financial statement are non-cash expenses recorded on?
What is financial accounting? How does it differ from managerial accounting?
Make sure you are properly citing your source(s) and providing your reference(s) for information you obtain from another source. Please review the Discussion Expectations and Grading posting if you have any questions regarding answering the discussion question and/or responding to your peers.

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