This post is based on “Annual Report for Fiscal Year 2009” by “The Department of Health and Human Services and The Department of Justice Health Care Fraud and Abuse Control Program(HCFAC, USA)” dated May 2010 from USA.
The purpose of the post is to create awareness on health care fraud existing in USA and the action taken by Obama government. Since, India is closely following western model for growth and most of the government employees, organized labor and people below BPL in Tamil Nadu are covered by medical insurance, we are likely to face the same situation that USA faces. Therefore, the solution also have to be copied from USA for effective utilization of tax payers’ money. Can we get a list of frauds of Indian health care organizations as given below by the Department of Justice, USA?
The Health Insurance Portability and Accountability Act of 1996 (HIPAA of USA) established a national HCFAC, USA to coordinate Federal, state and local law enforcement activities with respect to health care fraud and abuse. During Fiscal Year (FY) 2009, the Federal Government (USA) received $1.63 billion (Rs 8150 Crores) in judgments and settlements involving 1,786 potential defendants. A total of 583 defendants were convicted for health care fraud-related crimes during the year. Also in FY 2009, the Department of Justice (DOJ) opened 886 new civil health care fraud investigations and had 1,155 civil health care fraud matters pending.
| Fraud by | Fraud | Imprisonment in Months | Fine Amount
$ in millions |
|---|---|---|---|
| Florida | Physician (F)Co-conspirators 14 |
360 168 |
|
| Pharmaceutical Manufacturers | Pfizer |
2300.0 |
|
| Eli Lilly |
1400.0 |
||
| Bayer |
97.5 |
||
| Abbott |
28.0 |
||
| Kindred |
1.3 |
||
| Aventis |
95.5 |
||
| Physicians | In Mississippi, a Brookhaven psychologist. |
73 |
0.5 |
| Hospital | Methodist Hospital, Texas |
9.9 |
|
| City of Angels Medical Center, California |
10.0 |
||
| Regency Hospital Company, Ohio |
9.8 |
||
| Laboratories | QuestIts subsidiary, Nichols Institute Diagnostics (NID) |
46 262 |
|
|
Clinics |
The owner and operator (F) of a medical clinic in California |
72 | 4.7 |
| The owner (M) of a clinic, Florida |
70 |
4.0 |
|
| A Georgia man |
52 |
3.9 |
|
| Carlson Therapy Network |
1.9 |
||
| Two owners of a medical billing company, Florida.An employee. |
168 132 |
125.7 |
|
| The former owner of a DME supplier, Texas. |
60 |
1.6 |
|
| An owner/operator of a Texas DME company. |
70 |
3.2 |
|
| A DME company, Nationwide Medical, Inc., Florida and its CEO. |
2.0 |
||
| The President of DME supplier, Fl |
92 |
9.6 |
|
| A Florida man. |
121 |
3.3 |
|
| Nursing Homes | Regency |
4.0 |
|
| GPCC |
2.0 |
||
| Condell |
36.0 |
||
| UMDN |
8.3 |
||
| Neurometrix |
1.2 |
||
| Ferrell-Duncan Clinic |
1.0 |
||
| Other Medicare | The State of New York and New York City. |
540.0 |
|
| The owner of a mobile dental unit. |
41 |
1.7 |
|
| Yale University, Connecticut |
7.6 |
||
| The former Governor of the Passamaquoddy Tribe, Indian Township Reservation, Maine.The former Finance Director. |
12 12 |
1.7 1.6 |
|
| The owner of a health care company, Georgia. |
51 |
1.0 |
|
| The Federal Government |
2.2 |
I have included only those details of value more than $ 1 million. Once in a while, in India also raids are done for eye-wash. The US government has taken the matter seriously and trying to make the health care for all by establishing high power organizations operating jointly to detect, sentence and/or recover the fraudulently earned money.
I hope the Ministry of Health, India is aware of this and takes the issue seriously.
Jai Hind.
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