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Scholars, policymakers, and the media acknowledge that surveillance can threaten privacy and increase the risk of discrimination. Surveillance of people with disabilities, however, is positioned as being a convenient way of averting a host of problems: It can be seen as a way to protect people with disabilities from abuse and neglect, to prevent Medicaid fraud, and to proactively protect school communities from mass shootings. Increasingly, as surveillance systems become more sophisticated, state and federal laws have begun sanctioning, and occasionally mandating, the surveillance of people with disabilities for these purposes. This Essay interrogates narratives that justify the increased surveillance of people with disabilities by analyzing them through the lens of the Americans With Disabilities Act (ADA) and its integration mandate. The ADA expresses a clear goal of preventing the unnecessary segregation and isolation of people with disabilities. To achieve this aim, states must provide services, programs, and activities in the most integrated setting possible. Looking at laws and policies that mandate surveillance through the lens of integration draws attention to their oppressive and isolating effects. This Essay breaks new ground by centering disability discrimination in its analysis of surveillance. It is the first to demonstrate how ostensibly benevolent surveillance systems embed punitive, carceral practices within therapeutic and community-based settings. It yields new insights about how surveillance systems deployed within a community can result in a constrained and superficial, rather than expansive, idea of integration. [ABSTRACT FROM AUTHOR]

For decades, the Department of Justice (DOJ) has issued a steady flood of press releases announcing False Claims Act (FCA) settlements against health care entities and extolling the purportedly sharp message sent to the industry through these settlements about the consequences of engaging in wrongdoing. The FCA is the primary mechanism for government enforcement against health care entities engaged in wrongdoing, and it is expected to be DOJ's key tool for addressing fraud arising out of government programs in response to the COVID-19 pandemic. DOJ has pointed to three key goals of its enforcement efforts (deterrence, incentivizing cooperation, and building a culture of compliance in the health care industry). However, careful examination of the settlements touted in those DOJ press releases calls into question whether DOJ's settlement practices are conveying the message DOJ seeks to impart or having the impact it hopes to achieve. Virtually all FCA cases resolve without requiring the defendant to admit wrongdoing, and many defendants issue explicit public denials of wrongdoing when the resolution is announced. The absence of any need to admit wrongdoing has fueled a cost-of-doing-business narrative in which health care entities are required periodically to pay inconsequential settlements to the government regardless of their conduct. DOJ thereby risks both diminishing the general deterrence value of resolutions and lending credence to the vocal skepticism among industry and the defense bar that DOJ could, in fact, prevail at trial. DOJ's willingness to allow settlements in health care fraud cases without admissions is diametrically contrary to DOJ's policy in criminal cases, which is against permitting resolutions without defendants' clear and unequivocal acceptance of responsibility for violating the law. Permitting no-responsibility settlements in the civil FCA context suggests both that DOJ pursues, illegitimately, weak cases it cannot prove at trial, and potentially weakens the general deterrence value of civil FCA claims in general. New defendants may be left with cover that they are not wrongdoers but are merely ensnared in an illegitimate money grab. Even defendants who frankly recognize that they are in violation of the statute may be comforted that they likely face paying little more than restitution, and no significant penalties or social opprobrium. These practices suggest that DOJ rewards willingness to settle, and the monetary recovery it brings, above all other factors. DOJ's focus on settling and monetary recoveries in turn lends credence to the widespread belief that civil health care fraud settlements simply do not signal wrongdoing. There is no law, policy, or practice that prevents DOJ from requiring admissions in FCA settlements. Yet an in-depth review of nearly 200 FCA resolutions involving health care entities over the past two years reveals that approximately 92% did not include defendants' clear acceptance of responsibility, and approximately 37% involved defendants actively denying responsibility. The absence of any DOJ policy favoring admissions has important negative consequences, undermining DOJ's goals of deterrence, incentivizing cooperation, and building a culture of compliance. First, when corporate actors believe DOJ will pursue claims regardless of wrongdoing and the consequences of even a settlement will be relatively painless from a financial and reputational perspective, those actors have reduced incentive to put in place compliance structures dedicated to preventing wrongdoing. Second, and perhaps more importantly, when corporate actors diminish the force of settlements with DOJ by denying responsibility, they undermine the system's legitimacy vital for DOJ to encourage cooperation and for the government and well-meaning corporate actors to cultivate an industry-wide culture of compliance. This Article examines DOJ policy both from an economic incentive perspective and in light of research surrounding the psychology of legal authority, concluding that under both lenses DOJ undercuts its own goals. With DOJ actively reforming FCA policy and the FCA poised to take center stage in the government's fight against COVID-19 program abuse, it is beyond time to address this gap in DOJ's enforcement policy. [ABSTRACT FROM AUTHOR]

The article examines federal and state efforts to combat health care fraud by the U.S. Department of Justice (DOJ) and the Department of Health and Human Services (DHS). Topics discussed include statues to address Medicare and Medicaid fraud, types of health care fraud, including those regulating false claims, false statements, and mail and wire fraud and federal and state government agencies' enforcement efforts to investigate and prosecute health care fraud.

The article discusses the 2014 presentation made at the Annual Association of Healthcare Internal Auditors (AHIA) Conference in Austin, Texas, offering insight on auditing the exclusion monthly monitoring activities for Office of Inspector General (OIG) List of Excluded Individuals and Entities (LEIE) and state Medicaid Fraud Control Units. Some of the LEIE mistakes cited include ignoring others' lessons and OIG advice, poor communication on training protocols, and relying only on the OIG LEIE.

The article discusses the Medicaid payment arrangements under Section 360-7.5 (c) of Title 18 of the Official Compilation of Codes, Rules and Regulations of the State of New York (18 NYCRR) and the new requirement for opioid course. Topics include the recovery effort of the Medicaid Fraud Control Unit (MFCU), the need for dental professionals to take the opioid course for their dental continuing education, and the importance of the course to address the opioid abuse epidemic in the state.

The article discusses various legal aspects of health care fraud in America, focusing on the U.S. statutes which apparently address Medicare- and Medicaid-related fraud, as well as information about criminal law defenses such as false representation, good faith, and entrapment by estoppel. The U.S. Anti-Kickback Statute is mentioned, along with safe harbor provisions, prosecutions, and the U.S. Health Insurance Portability and Accountability Act of 1996. Mail and wire fraud are examined.

The literature indicates Medicaid fraud is pervasive and comprises a substantial portion of health care spending. One type of Medicaid fraud that has not been explored is durable medical equipment fraud. This study seeks to fill this gap in the literature by examining the characteristics of durable medical equipment fraud cases investigated by Medicaid Fraud Control Units. Content analysis was used to review 258 reported cases of durable medical equipment fraud. The findings indicate that providers engage in a range of offenses and are subject to a variety of sanctions. Policy implications and recommendations for future research are provided. [ABSTRACT FROM PUBLISHER]

The article discusses health care fraud in the U.S. as of March 2012, focusing on an analysis of the nation's Medicaid False Claims Statute, as well as several defenses to allegations of criminal health care fraud such as unconstitutional vagueness and entrapment by estoppel. The U.S. The Health Insurance Portability and Accountability Act of 1996 is also addressed, including information on the crimes of theft and embezzlement in relation to health care.

The article presents information on several circuit court cases relating to products liability law. These cases cover several aspects in theories of liability including design defect, duty of care, and failure to warn. It presents a case Dunn v. Nexgrill Industries, Inc. in which action against defendant was brought by the plaintiffs who sought claims for alleged fire accident occurred by a design defect in the cabinet of the grill. The defendant moved for summary judgment, which was granted by the district court. Information on a case in which Medicaid False Claim Act (MFCA) has been discussed is also presented.

This paper reports on key aspects of welfare fraud in Australia. It begins by outlining the basic aims of welfare systems that provide direct economic support, the vulnerability of these systems to fraud and issues around culpability and appropriate responses to suspected fraud. The paper also describes problems experienced when attempting to measure fraud and provides an analysis of available data about the size and dimensions of the problem, including case studies of major frauds. Overall, demonstrable fraud represents a very small fraction of all welfare transactions, but it also represents significant losses, demand for prosecution and loss recovery action. Overall, there is a need for greater consensus on the best ways to prevent fraud and deal with offenders. [ABSTRACT FROM AUTHOR]

The article discusses the factors to be considered in the Medicaid law enforcement field by dental professionals in New York. It highlights the issues that dentists must deal with cautiously including Medicaid integrity contractors (MICs), the Medicaid Fraud Control Unit (MFCU), and the Recovery Audit Contractors (RACs). It also notes to consider the Office of Medicaid Inspector General (OMIG).

The article focuses on health care fraud in the U.S. Topics include safe harbor provisions, Medicare and Medicaid fraud, and the doctrine of entrapment by estoppel. Information is provided on the Health Insurance Portability and Accountability Act of 1996 and the U.S. federal government's ability to prosecute health care fraud through statutes.

An essay is presented on the different perspectives on health care fraud that follows the money. It explores the key attributes making the health care system a target for fraud, discusses the financial incentives that affect the group's behavior, and offers insights on the future of the anti-fraud agenda in health care reform. It mentions the implication of the reliance on documentation of services rendered and the persistence of decentralized health care system.

Hospitals and health care providers tend to get involved in exaggerated and fraudulent medical claims initiated by national insurance schemes. The present study applies data mining techniques to detect fraudulent or abusive reporting by healthcare providers using their invoices for diabetic outpatient services. This research is pursued in the context of Taiwan’s National Health Insurance system. We compare the identification accuracy of three algorithms: logistic regression, neural network, and classification trees. While all three are quite accurate, the classification tree model performs the best with an overall correct identification rate of 99%. It is followed by the neural network (96%) and the logistic regression model (92%). [ABSTRACT FROM AUTHOR]

The feature outlines recent developments in the way several countries in Europe have cooperated to counterfraud and corruption against their healthcare systems. Although the delivery of healthcare differs across Europe, nonetheless the frauds and acts of corruption committed against them are similar and the issues surrounding countering fraud and corruption are familiar ones. As a result, cooperation and sharing best practice can only benefit participants. [ABSTRACT FROM AUTHOR]

The article discusses how to deal with government health care fraud investigations, particularly to Florida Office of Attorney General, Medicaid Fraud Control Unit (MFCU) investigations. The role of MFCU is to perform both criminal and civil investigations of reimbursement fraud and criminal investigations regarding alleged patient abuse, neglect, and exploitation. It is advised to consult with a health lawyer if a person is not regularly engaged in a health law compliance practice.

The article discusses health care fraud in the United States and the failure of the fraud enforcement system to compensate injured beneficiaries. Topics include how patients are harmed by health care fraud, including financial, physical, and intangible harm, and barriers to patient compensation. Laws mentioned include the Medicare and Medicaid Anti-Kickback Statute, the Racketeer Influenced and Corrupt Organizations Act (RICO), and the Civil False Claims Act, which can be applied to fraud recovery. There is a recommendation for a patient-centered model.

The current study examines the nature and frequency of Medicare/Medicaid fraud and the techniques of neutralization utilized by a purposeful sample of speech, occupational, and physical therapists working within the context of hospitals, nursing homes, and with home health agencies, in a southern state. Participant observations, surveys, and in-depth interviews were utilized to obtain data for this study. We identified two main fraudulent practices, cutting sessions short while charging for the entire session and charging individual session rates for group therapy sessions. We also identified three techniques of neutralization utilized by the therapists in our study, including: (1) everyone else does it, (2) denial of responsibility, and (3) denial of injury. The implications of our findings are discussed. [ABSTRACT FROM AUTHOR]

Comments on major points of David Hyman's study on the federal system for fraud control in the Medicare and Medicaid programs in the United States. Hyman's failure to focus on structural features in the Medicare program that encourage undesirable billing practices; Pessimistic view of Hyman on the private-sector cost control techniques; Problems with the medical fee-for-service structure; Use of fraud law to pursue cost and quality goals.

Discusses the state of the law covering federal health care fraud and its enforcement in the United States. Statutes on false claims, false statements, mail and wire fraud; Statutes to address Medicare and Medicaid fraud such as the anti-kickback prohibition, self-referral/stark amendments, Health Insurance Portability and Accountability Act of 1996; Safe harbor provisions; Enforcement.

Studies Medicaid eligibility rules for elderly applicants for long-term care. History and background of the Medicaid program; Income-first or resource-first rule of the program; Legislation aimed at preventing the fraudulent transfer of assets for purpose of achieving Medicaid eligibility.

Presents a series of miscellaneous facts from around the United States. Estimated amount of conviction secured by Medicaid Fraud Control Units; Number of states which formed partnerships with the National Council for the Accreditation of Teacher Education; Amount of elderly people who have long-term care insurance.

The question of punishment of white-collar criminals is addressed in this paper through an examination of sanctions imposed on health care providers convicted of defrauding California's Medicaid ("Medi-Cal") system. Quantitative data were collected from Medi-Cal case files and, for comparative purposes, from a statewide data base maintained by the California Bureau of Criminal Statistics for grand theft arrestees. Qualitative data comprising interviews with Medi-Cal enforcement personnel supplement the analysis. The analysis of criminal sanctions reveals greater leniency in the punishment of Medi-Cal offenders than in the punishment of similarly charged non-white-collar offenders. The findings are related to recent debates regarding the severity of punishment for white-collar offenders. [ABSTRACT FROM AUTHOR]

Investigates the commission of fraud in Medicare and Medicaid, health care insurance programs in the United States. Falsification of claims reimbursements as fraud; Elements for commission of Medicare and Medicaid fraud; Protection granted to physicians under the safe harbors provisions; Health care fraud within civil, criminal and administrative actions.

The Medicare and Medicaid programs have been burdened with health care providers' fraudulent and abusive practices since their implementation in 1965. To help states discover and prevent Medicare and Medicaid fraud, Congress has enacted statutes permitting access to patients' medical records in investigations of fraud. The majority of states have enacted physician-patient and psychotherapist-patient privilege statutes to protect confidential information from disclosure. Thus, the state's need for patient information conflicts with the patient's right of privacy. This Note discusses several court decisions that have wrestled with the tension between these two policies. The courts, after balancing the state interest in eliminating fraud against the patient's privacy interest, have often allowed disclosure of patient medical records. Although some courts have attempted to limit the extent of the information disclosed, few have set forth explicit standards to protect patient records from unwarranted disclosure of confidential information. This Note suggests guidelines for courts, legislatures and health care providers to uniformly limit the extent of this disclosure. [ABSTRACT FROM AUTHOR]

This research examines the characteristics, consequences, and potential factors impacting the prevalence of prescription fraud committed by pharmacy employees. Using standard thematic content analysis, 292 cases prosecuted by Medicaid Fraud Control Units throughout the nation are analyzed. Preliminary results reveal that certain kinds of fraud (generic substitution, short-counting, and filling prescriptions without a refill) are committed more regularly, or at least detected more readily than other kinds of fraud. Most of the prosecutions involved pharmacists accused of fraud and many of the offenses were committed in groups. Implications for future research and policy are provided. [ABSTRACT FROM AUTHOR]

Discusses the Medicare and Medicaid anti-kickback statute called the Social Security Amendments of 1972. Safe harbor regulations; Concern over interpretation of the statute; Fraudulent practices monitored by the Office of the Inspector General (OIG) of the Department of Health and Human Services.

The article discusses a study on white-coat crime or provider Medicaid fraud in New York in 1977. The reluctance of criminologists to pursue alternative techniques for determining the prevalence of such crime is attributed to the difficulties of applying current measurement strategies to upperworld crime. Results show that the rate of occupational criminality is influenced by the professional or business orientation of a provider specialty. Also noted is the financial costs of duplicate billing in New York City including the responsibility of pharmacies for losses of more than 4.5 million dollars. It predicts an increase in provider criminality in the future in light of surpluses of physicians and attenuation of professional prohibitions against advertising.

Summarizes the National Association of Medicaid Fraud Control Units (NAMFCU) survey data and report on the law enforcement initiatives across the United States on crime against elder in health care facilities. Types of institutional patient crime; How the data gathered from the survey were analyzed; Penalties for crimes against elderly committed by nursing home employees.

The article focuses on the healthcare anti fraud initiative. Topics discussed include the low dollar percentage return on transaction in Medicare and Medicaid which leads temptation to commit fraud, several notable healthcare providers involved in fraud cases including the Coventry Health Care, Pfizer, and WakeMed Health and Hospitals, and the six steps for anti healthcare fraud.

Based on three years experience in the New York City Health Department, abuses in the provision of Medicaid are analyzed and methods for dealing with those involved are described. [ABSTRACT FROM AUTHOR]

The article reports that the U.S. Congress members are dabbling on the issue of increasing Medicaid waste, fraud, and abuse. In order to prevent the misuse of Medicaid program in the U.S., the Congress has proposed cutting Medicaid's budget by $10 billion over the next five years. It is suggested that one of the most effective sources the government has in uncovering complex corporate fraud against Medicaid and returning ill-gotten gains to federal and state treasuries are whistleblower lawsuits filed under the federal False Claims Act. Under the provision, whistleblowers are entitled to 15-30% of monies recovered by the federal government in the outcome of a lawsuit.

Focuses on the resources devoted by both federal and state governments in the United States to combat fraud against the Medicare and Medicaid programs. Types of fraud; Laws in health care fraud.

Explores the issue of fraud in the Medicare and Medicaid programs of the United States. Financial implications of fraud; Insight into ease of committing Medicare and Medicaid fraud; Gift giving as art form. INSET: Fraud cases range from the sublime to the ridiculous..

The article focuses on admonition is the lowest sanction in the disciplinary process set forth in Missouri Supreme Court Rule 5. It mentions admonitions are for minor rule violations that do not invoke formal discipline by the Supreme Court. It mentions examples of admonition summaries legal representation of client with Medicaid fraud, lawyer on a Bar admission application failed to disclose a university sanction for plagiarism and prevention of foreclosure on the clients' home.

The article highlights individuals, groups, and dental issues that merited either praise or criticism in 2006. Japan's Omori Group provides its dental personnel with specialized courses that feature voice training. Voters in Burlington and Montpelier, Vermont endorsed a measure to keep fluoride in the municipal water supply of both communities. Dentist Julia Boginsky admits she defrauded the Medicaid program over a 6-year period.

Focuses on the prevention of Medicaid fraud and state medical benefits applications in Arizona. Details of the Eligibility Fraud Prevention Program; Obstacles in implementing the program; Statistics on the frequency of attempted fraud.

Presents a court decision on a case concerning Medicaid fraud by a dentist in New York. License revocation of the convicted physicians; Petition of the defendant for a judicial review of the revocation.

Discusses several studies on laws and regulations which cover health care fraud in the United States. Anti-Kickback Statute; Medicare Safe Harbor Regulations; Self-referral prohibitions.

The article presents information on the activities of the Council on Psychiatry and Law of the American Psychiatric Association (APA) as reported at the fall component meetings of the APA in Washington D.C., on September 12-16, 1990. The APA Board of Trustees approved a document in December 1989, which is relevant to right of psychiatric patients to refuse medication. A meeting of the council held in May 1990 focused on investigations and prosecutions involving Medicaid fraud.

The article discusses the development on the move by the federal government to fight against health care fraud on Medicare, Medicaid and the Children's Health Insurance Program (CHIP) in the U.S.

The article reports on the settlements made by four drug companies with the U.S. Department of Justice for Medicaid fraud. Such companies include Mylan Pharmaceuticals, UDL Laboratories, Astra Zeneca and Ortho McNeil. They agreed to pay a total of 124 million U.S. dollar to settle the false claims that they submitted to the U.S. Medicaid program following the complaint of a whistleblower. In addition to the settlement, the drug companies also agreed to offer rebates to the Medicaid program.

A decision is expected this month from the Supreme Court justices in the Sell v. U.S. case, which will decide whether a mentally ill St. Louis dentist accused of Medicaid [...]

The article states that the Government Accountability Office (GAO) released a report, "Medicaid Financial Management: Steps Taken to Improve Federal Oversight but Other Actions Needed to Sustain Efforts." The June 30 report, which is available at the GAO website, indicates that the Centers for Medicare & Medicaid Services (CMS) needs to improve its financial management to stop waste in spending and prevent fraud. There needs to be a mechanism for measuring the risk for inappropriate reimbursement.

This article presents the results of an investigation conducted by the New York Times as of July 2005 regarding the declining number of Medicaid fraud investigators in New York. The state's Medicaid program pays more than a million claims a day, feeding a $44.5 billion river of checks to radiologists and ambulance drivers, brain surgeons and orderlies, medical centers and corner pharmacies. Many who get those checks pocket more money than they deserve, and millions of taxpayer dollars are believed to be lost every day to theft and waste. Yet the state, charged with protecting those dollars, has done little to stop them from draining away. The investigation found only a thin, overburdened security force standing between this enormous program and the unending attempts to steal from it. Even as spending by New York Medicaid has more than tripled since the late 198O's, the number of fraud investigators who guard its cash register has fallen by half, and several of their leaders have quit or retired in disillusionment.

Reports on the reimbursements owed by drug manufacturers to the states in the U.S. for the settlement of Medicaid fraud charges. Use of the settlement money for the funding of public schools and for the Medicaid programs of the states; Requirement of the state for drug manufacturers to provide certain pricing concessions; Companies affected with the Medicaid fraud settlements.

Reports that a joint venture of Takeda Chemical Industries and Abbott Laboratories, TAP Pharmaceutical Products, has agreed to settle criminal and civil charges that it had illegally manipulated the Medicare and Medicaid programs. Accusation that TAP gave doctors free samples of leuprorelin acetate for which they were reimbursed and gave the doctors kickbacks for prescribing the drug; Response from Thomas Watkins, president of TAP; Prosecution of five doctors involved in the fraud.