Phantom Billing Fake Prescriptions And The High Cost Of Medicine

U.S. health care is a $2.5 trillion system that accounts for more than 17 percent of the nation’s GDP. It is also highly susceptible to fraud. Estimates vary, but some observers believe that as much as 10 percent of all medical billing involves some type of fraud. In 2009, New York’s Medicaid fraud office recovered $283 million and obtained 148 criminal convictions. In July 2010, the U.S. Justice Department charged nearly 100 patients, doctors, and health care executives in five states of bilking the Medicare system out of more than $251 million through false claims for services that were medically unnecessary or never provided. These cases only hint at the scope of the problem. In Phantom Billing, Fake Prescriptions, and the High Cost of Medicine, Terry L. Leap takes on medical fraud and its economic, psychological, and social costs. Illustrated throughout with dozens of specific and often fascinating cases, this book covers a wide variety of crimes: kickbacks, illicit referrals, overcharging and double billing, upcoding, unbundling, rent-a-patient and pill-mill schemes, insurance scams, short-pilling, off-label marketing of pharmaceuticals, and rebate fraud, as well as criminal acts that enable this fraud (mail and wire fraud, conspiracy, and money laundering). After assessing the effectiveness of the federal laws designed to fight health care fraud and abuse—the antikickback statute, the Stark Law, the False Claims Act, HIPAA, and the food and drug laws—Leap suggests a number of ways that health care providers, consumers, insurers, and federal and state officials can bring health care fraud and abuse under control, thereby reducing the overall cost of medical care in America.

This title argues that the trust-intensive nature of the financial services industry makes it essential to rebuild trustworthiness in the provision of financial services. It considers the lack of trust that emerged following deregulation of the financial sector and examines what is needed to rebuild trustworthiness.

This book grapples with the numerous risks organizations face in order to succeed. These include economic risks, disaster risks, supply-chain risks, regulatory risks, and technology risks, all of which affect organizations in different ways and in varying degrees. Referencing Mahatma Gandhi’s seven unethical behaviors in the business world—wealth without work, pleasure without conscience, knowledge without character, commerce without morality, science without humanity, religion without sacrifice, and politics without principle—the authors analyze the healthcare sector. As competition in the health sector increases, there has also been a rise in unethical behavior. Corruption in the health sector results in severe consequences as it could affect the health of millions. This volume explores fraud schemes and cases, legislation to avoid cheating, lack of law, transparency, ethical issues, corporate governance and transparency in the health and pharmaceutical sector bringing together the perspectives of practitioners, professionals, as well as academic authors.

This book examines various aspects of ethnomedicine and tribal healing practices, including its importance for inclusion and integration from a health systems perspective. Tribal healing practices is an under-studied component in healthcare system, health policy and health systems research. The book consists of original research papers based on empirical studies done by anthropologists, sociologists, public health practitioners and research scientists in various parts of India. It discusses issues of non-codified folk healing, with a focus on the therapeutic ideas and practices of tribal communities, located in anthropological theory and methods. It has a balance of empirical papers, review and theoretical papers, not only explaining ‘what is inside the healing practices’ but also touching upon the question of ‘why’ and delving into ‘what should be’ looking into the possibility to apply it for a larger good i.e., health care for all. This book discusses several important issues related to legitimacy, evidence and efficacy, recognition, certification and integration, protection and preservation, bio-piracy and bioprospecting, benefit sharing and intellectual property rights, sustainable use of medicinal herbs and conservation of nature and natural resources, biodiversity and possibilities of mainstreaming tribal healing. It is of interest to students and researchers from medical anthropology, medical sociology, cultural geography, liberal studies, tribal studies, ecology, sustainability and development and public health.

This book presents a variety of discussions from different countries about regulations and applications of ethics in business practice. It demonstrates how Ethics, both in the world of business and in academic life, is consistently a central and unavoidable issue that institutions must devise new regulations on a regular basis to address. Given that applying such regulations becomes complicated in a global business landscape and that International companies have lost large amounts of revenues due to fraudulent activities, the book provides insights for professionals in business world to teach, learn, apply, measure and report on companies' daily business. Business and Professional Ethics: Theories, Standards, and Analysis is essential reading for researchers and students in business schools around the world.

Justice, Crime, and Ethics, a leading textbook in criminal justice programs, examines ethical dilemmas pertaining to the administration of criminal justice and professional activities in the field. Comprehensive coverage is achieved through focus on law enforcement, legal practice, sentencing, corrections, research, crime control policy, and philosophical issues. The contributions in this book examine ethical dilemmas pertaining to the administration of criminal justice and professional activities in the field.

A distinctive new account of why markets focus on short-term goals, while government needs to concentrate on society's long-term interests.

Crime and Everyday Life, Fifth Edition, offers a bold approach to crime theory and crime reduction. The text shows how crime opportunity is a necessary condition for illegal acts to occur. The authors offer realistic, often common-sense, ways to reduce or eliminate crime and criminal behavior in specific settings by removing the opportunity to complete the act. Using a clear and engaging writing style, author Marcus Felson and new co-author Mary Eckert talk directly to the student about criminal behavior, the routine activity approach, and specific crime reduction ideas. The authors emphasize how routine daily activities set the stage for illegal acts -- offering fascinating new ideas and examples not presented in earlier editions. Most importantly, this book teaches the student how to think about crime, and then do something about it.