False Claims and Health Care Essay Example | Topics and Well Written Essays - 750 words

False Claims and Health Care - Essay Example The primary source of fraud in health care is through false claims. False claims are illegal and punishable through The False Claims Act, otherwise known as "Lincolns' Law". This law was enacted during the Civil War, updated by Ronald Regan in 1986 and contains "qui tam" provisions allowing ordinary citizens to sue on behalf of the government and collect restitution. (Phillip and Cohen) Also, under U.S. Code Title 18 Part I Chapter 63 section 1347 health care fraud is punishable by fine, or imprisonment for up to 10 years, or in cases of death a life sentence. There are many types of false claims. Services not rendered is best described as billing for services that were never delivered to patients. Physicians simply add on a few extra services that they did not perform for the patient. A common example would be when ordering a complete blood count (CBC) for a patient to bill for additional blood chemistry tests that doctors hadn't performed. In this very situation, two emergency room doctors were paid $92 million after bringing to light a "whistleblower" suit against Columbia/HCA. (Phillips & Cohen) Lack of Medical Necessity is another term used to describe a situation when a doctor or health care provider bills the insurance for procedures that are not necessary. This type of fraud is combated by practices put into place by the insurance companies such as; yearly benefit maximums, and restrictions on the number of procedures you can have. However, too often illegitimate claims are made. For example, a New York radiologist was sentenced under the False Claims Act to one to three years in prison and excluded from Medicare and state health care programs for 10 years for billing Medicaid for "thousands of medically unnecessary, duplicative, forged and unreadable sonogram tests." (Phillips & Cohen) Kickbacks are another borderline form of health care fraud. This is the most complicated and hidden form of fraud. It involves an improper monetary or material benefit to the health care provider for prescribing or using a certain product or service. In simpler terms, someone pays a doctor per patient he will prescribe a medicine to, or perform an expensive test on. A fine example comes from a group of five hospitals in Kansas and Missouri, which paid doctors per referral to it's "geriatric center". The group of hospitals was sentenced to pay $1.2 million in restitution under the False Claims Act. There is a anti-kickback statue written into Medicare, but often the kick backs are hard to track and difficult to discover. This is an area where "whistleblowers" are most effective as it alerts the proper authorities to a scam operating. Health care fraud will continue to be an issue as long as our current system of health insurance and care is operating. There are many flaws in the system and it is barely limping along. Many other countries, notably France, Australia, and the Netherlands have developed systems that are proven to be much more cost effective than the current American system. Fraud will continue as long is there is opportunity; the solution is to significantly lessen the opportunity and increase the punishment. Bibliography An, Jane Saloner, Romy and Ranji, Usha The Henry J. Kaiser Family Foundation "U.S. Health Care Costs" Updated January

Limited Liability Partnerships Essay Example | Topics and Well Written Essays - 1250 words

Limited Liability Partnerships - Essay Example While a limited company is formulated as a legal entity where limited liability exists, this was not so in the case of partnerships, which were not legal entities and thereby made partners legally liable for all the firm's debts. The Limited Liability Partnership has the following features (a) it has a separate legal personality (b) liabilities of individual members are limited to the amount they agree to pay in the event of an insolvency (c) partners are expected to adhere to the duties and obligations currently imposed upon Directors of Companies (d) the LLP is not expected to hold AGMs or observe the rules for shareholder protection set out in the Companies Act and (e) agreements about how the affairs of the LLP will be run are left to the discretion of individual members, but partners are entitled to share in the management of the firm on an equal basis (Davies, 2001). Dr. Michael Twomey, a partnership lawyer, points out the advantages of a partnership. Firstly, it allows the partners the freedom and flexibility to conduct the Company's affairs as they wish and are not subject to the provisions of Company law. Secondly, they are not required to file accounts; hence their accounts are not publicly scrutinized. Thirdly, since a partnership is not a legal entity, hence no partnership tax is levied and the firm does not pay tax, only the partners do(MOE, 2002). But this singular advantage offered by partnerships, of privacy in the manner in which internal operations of the firm are conducted, is eliminated by way of the LLP, because such privacy can no longer be retained when LLPs are required to file audited accounts at the Companies House and to also disclose information about profits and the share of profits accruing to the highest earning partner (Davies, 2001). As a result, the financial affairs of partnerships will now be brought under public scrutiny and partners will be required to divulge details of profits accrued as well as shares of such profits that are being routed to the partners. One of the reasons why the LLP has been advanced is to mitigate the legal liability of partners for the debts of the firm. This need was especially highlighted in the aftermath of scandals such as Enron, where the Arthur Anderson partners who were not theoretically related to the Enron case, could still be held liable for repayment of debts. But in practice, companies in Britain have not demonstrated any eagerness in coming forward to be incorporated as LLPs. As pointed out by Towmey (MOE, 2002), Clifford Chance, the biggest law firm in London, chose to become an LLP based in America rather than an LLP based in Britian, because in effect, the LLP in Britain has lost all the advantages of financial privacy and flexibility of a partnership. While a partnership was earlier not taxed, most of the principles of Company law have now been applied to it under the LLP format, as a result of which it has to function as if it is a Company rather than a partnership. Thus, it may be noted that the LLP has failed to address one of the most pressing reasons why it was introduced, i.e., the need to ensure that partners are not held liable for the firm's debts. This aspect was vital especially in the case of small businesses where incorporating as a Company is not a feasible option because it involves too much expense and