LP6.1 Assignment: Fraud and Abuse.Directions:Complete the Problem below and a three page answer the...

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LP6.1 Assignment: Fraud and Abuse.Directions:Complete the Problem below and a three page answer the following.You are outside counsel to the Marcus Welby Healthcare Corporation, which among its other operations owns a durable medical equipment (DME) subsidiary, which sells equipment for home use such as crutches, wheelchairs, and oxygen concentrators. You learn that the subsidiary has had certain business practices about which you have some question under the Medicare and Medicaid Anti-Fraud and Abuse provisions:• Salesmen regularly offer home health agency employees a “premium” whenever their clients order DME from the subsidiary.• The subsidiary offers “rebates” to patients who use its equipment.• The subsidiary pays hospital and home health agency personnel for assisting its patients in learning how to use its products.• Some arterial blood gas test results may have been “massaged a bit” by the DME in order to facilitate Medicare payment for oxygen concentrators.What advice would you give?
	
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David · Accepted Answer

Medicare and Medicaid Fraud Prevention 
Introduction 
As an outside counsel of the Marcus Welby health care cooperation that owns a 
durable medical equipments subsidiary, suggestions are offered to the company to follow the 
Medicare and Medicaid anti fraud abuse provisions. It is found that salesman offers the home 
health agency employees premium for referring the clients who purchase the products from 
the agency. Subsidiary offers rebates to those patients that use its equipments. Subsidiary also 
takes the services of hospital and home health agency personal and pays them for their 
service to assist patients in learning about agency products. The arterial blood gas has been 
found to be manipulated by the DME to facilitate the Medicare payment. Under these 
unethical practices, some suggestions are offered 
Main body 
There are many acts that are provided by the Medicaid and Medicare for prevention of 
fraud. 
Federal false claims act 
The FCA protects the government to being overcharged or to sell substandard 
commodities or services. To prevent this, FCA has imposed the civil liability on a person 
who deliberately submits, or becomes a cause to submit a fake claim to the government of 
America. Here the term knowingly and knowing mean person has knowledge about 
something wrong and he acts deliberately to hide this or shows a reckless disregard to the 
issue.  
The abuse of Medicare and Medicaid program reflects such practices where person or 
agency directly or indirectly involves in resulting unnecessary costs to the Medicare program. 
The examples of Medicare abuse are billing for unnecessary medical services, charging much 
for services, misusing the codes on claim and others.

LP6.1 Assignment: Fraud and Abuse . Directions: Complete the Problem below and a three page answer the following. You are outside counsel to the Marcus Welby Healthcare Corporation, which among its...

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