Government Abuse
Government Abuse

Author: William Sims Curry

Publisher: Routledge

Published: 2017-07-28

Total Pages: 217

ISBN-13: 1351516787

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Government contracting is plagued by nefarious, amateurish, and criminal behavior. By awarding government contracts to corporations as compensation for lavish gifts and personal favors, the United States government fails to serve the public interest effectively and honestly. William Sims Curry identifies and categorizes multiple deficiencies in how government contractors are selected, and proposes how reforms can be instituted.This book is based on extensive research. Curry sifted through two years worth of contractor claims maintained by the Government Accountability Office (GAO) regarding improper behavior of federal government agencies during the contract award process. He identified additional government contracting failures through review of media stories, inspector general reports, court cases, and press releases by government investigatory agencies.Much of this abuse originates from the mandated but ineffective practice of color coding rating proposals and a subjective ratings system. Curry proposes replacing the current practice with a scoring system that weighs contractor selection criteria according to the government's needs. This, along with the other procurement reforms Curry recommends, offers promise for an alternative to the fraud, waste, and incompetence currently rampant in government contracting.

Health Care Fraud and Abuse
Health Care Fraud and Abuse

Author: Aspen Health Law Center

Publisher:

Published: 1998

Total Pages: 156

ISBN-13:

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Stepped-up efforts to ferret out health care fraud have put every provider on the alert. The HHS, DOJ, state Medicaid Fraud Control Units, even the FBI is on the case -- and providers are in the hot seat! in this timely volume, you'll learn about the types of provider activities that fall under federal fraud and abuse prohibitions as defined in the Medicaid statute and Stark legislation. And you'll discover what goes into an effective corporate compliance program. With a growing number of restrictions, it's critical to know how you can and cannot conduct business and structure your relationships -- and what the consequences will be if you don't comply.

The Art of the Watchdog
The Art of the Watchdog

Author: Daniel L. Feldman

Publisher: SUNY Press

Published: 2014-01-01

Total Pages: 356

ISBN-13: 1438449291

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Expert advice on how any citizen can fight government fraud, waste, abuse, and corruption. Does government fraud, waste, abuse, and corruption make your blood boil? In The Art of the Watchdog, Daniel L. Feldman and David R. Eichenthal show how to fight back. Based on their own work in federal, state, and local government over the last forty years, they will arm you with the tools and techniques needed to put the spotlight on those who cheat and steal from the public or who squander valuable taxpayer dollars through waste and inefficiency. At the same time, Feldman and Eichenthal outline what they see as the good and the bad of current oversight efforts based on case studies from across the nation. Ultimately their goal is to ensure that the “art of the watchdog” does not become a lost one and to improve the quality and integrity of government and strengthen democracy. “In The Art of the Watchdog, Feldman and Eichenthal offer a comprehensive overview of the world of oversight from the perspective of two authors who have been around the block a time or two. If you want to understand the different forms of watchdogs and how they both succeed and fail, there is no better resource available.” — Neil M. Barofsky, author of Bailout: How Washington Abandoned Main Street While Rescuing Wall Street “This is simply the best book written on the government watchdog function. It smartly explains how a persistent, gutsy, and empirical watchdog can be a tugboat moving supertankers.” — Mark J. Green, former New York City Public Advocate and author of Who Runs Congress? “Who really watches out for abuses and waste in government? Often it is committed public servants who understand that oversight is part of doing the people’s business. Feldman and Eichenthal show how effective watchdogs can lead to better government performance and improved public confidence.” — Tom Griscom, former White House Communications Director in the Reagan administration

Healthcare Fraud, Corruption and Waste in Europe
Healthcare Fraud, Corruption and Waste in Europe

Author: Misja Mikkers

Publisher:

Published: 2017

Total Pages: 0

ISBN-13: 9789462366855

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The lack of well-documented, factual information on fraud, waste and corruption in the healthcare sector is an important ally for those who would seek to abuse healthcare systems for their own profit. Our lack of knowledge of the incidence, nature and extent of fraud, waste and corruption in healthcare is a threat to the establishment of effective counter-fraud strategies. It prevents those who finance healthcare provision from understanding in clear and quantifiable terms the need to invest resources into counter-fraud activities. As a consequence, fraud remains a matter of moral hazard and healthcare systems continue to suffer considerable financial damage, as well as all the associated consequences for the quality of care that patients receive. It was for these reasons that the 'European Healthcare Fraud and Corruption Network' (EHFCN) and the 'Dutch Healthcare Authority' (NZa, member of EHFCN) decided to collaborate to publish this book... --

Tackling Wasteful Spending on Health
Tackling Wasteful Spending on Health

Author: OECD

Publisher: OECD Publishing

Published: 2017-01-10

Total Pages: 306

ISBN-13: 9264266410

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Countries could potentially spend significantly less on health care with no impact on health system performance, or on health outcomes. This report reviews strategies put in place by countries to limit ineffective spending and waste.

Section 1557 of the Affordable Care Act
Section 1557 of the Affordable Care Act

Author: American Dental Association

Publisher: American Dental Association

Published: 2017-05-24

Total Pages: 60

ISBN-13: 1941807712

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Section 1557 is the nondiscrimination provision of the Affordable Care Act (ACA). This brief guide explains Section 1557 in more detail and what your practice needs to do to meet the requirements of this federal law. Includes sample notices of nondiscrimination, as well as taglines translated for the top 15 languages by state.

Fraud and Abuse Investigations Handbook for the Health Care Industry
Fraud and Abuse Investigations Handbook for the Health Care Industry

Author: Paul W. Shaw

Publisher:

Published: 2021

Total Pages: 775

ISBN-13: 9781663315007

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The authors examine each stage of a fraud and abuse investigation, beginning with an overview of federal and state enforcement agencies, and concluding with a discussion of the potential collateral consequences of an investigation. They have supplemented their analysis extensively with sample documents, including indictments, requests for records, subpoenas, internal response memoranda, and responses to auditors, prosecutors, and more. Taken together, the materials in this book provide a true Handbook for anyone who needs to quickly and thoroughly understand the complex nature of a government fraud and abuse investigation.-Preface.

The Inspector General Handbook
The Inspector General Handbook

Author: Joseph E. Schmitz

Publisher:

Published: 2013

Total Pages: 575

ISBN-13: 9780578004365

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This book is an in-depth look at the experiences of the former head of the Pentagon's Office of Inspector General-the most expansive IG organization in the world-from 2002-2005. The Handbook is designed not only for teaching and training professionals assigned to Offices of Inspector General throughout the US federal and state governments, but also for the benefit of government and corporate leaders who will need, sooner or later, to deal intelligently with an IG. "Important reading for every inspector general."-DONALD RUMSFELD Secretary of Defense of the United States, 1975-1977 and 2001-2006 "Nobody knows the history, traditions, and functions of an Inspector General better than Joe Schmitz. The Inspector General Handbook is a practical guide for anyone working within an IG office who wants to serve in a constitutionally sound role as part of the leadership team. The IG in any organization should detect organizational performance problems early, and should enable rapid responses so that systemic problems can be addressed before they spread further or cause irreversible damage. This first-ever IG Handbook sheds light on an area of American government that is often misunderstood, frequently maligned, and yet indispensable to the functioning of our republic. This book is a 'must read' for all government leaders and for every lawyer who needs to know by what authority and for what purposes an Inspector General serves 'We the People' of these United States." -JOHN ASHCROFT former U.S. Senator and Attorney General of the United States, 2001-2005 "The office of Inspector General can seem highly problematic, located within each executive department but reporting not only to the head of the department but also to Congress and, through Congress, to the public. Schmitz carefully examines the nature of the institution, and demystifies it while at the same time promoting respect for it. The Inspector General Handbook is a work of lasting value." -MICHAEL B. MUKASEY Attorney General of the United States, 2007-2009, and U.S. District Judge for the Southern District of New York, 1988- 2006 "Joe Schmitz' Handbook delivers a previously missing link in the understanding of post-9/11 law enforcement professionals who take an oath to support and defend the Constitution of the United States against all enemies, foreign and domestic. Of all public sector professionals, Inspectors General should be transparent; the American People ought never to wonder why an IG does what he or she does. And with Joe's Inspector General Handbook, that transparency is now achieved." -LOUIS J. FREEH Director, Federal Bureau of Investigation, 1993-2001

Healthcare Fraud
Healthcare Fraud

Author: Rebecca S. Busch

Publisher: John Wiley & Sons

Published: 2012-05-01

Total Pages: 374

ISBN-13: 1118179803

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An invaluable tool equipping healthcare professionals, auditors, and investigators to detect every kind of healthcare fraud According to private and public estimates, billions of dollars are lost per hour to healthcare waste, fraud, and abuse. A must-have reference for auditors, fraud investigators, and healthcare managers, Healthcare Fraud, Second Edition provides tips and techniques to help you spot—and prevent—the "red flags" of fraudulent activity within your organization. Eminently readable, it is your "go-to" resource, equipping you with the necessary skills to look for and deal with potential fraudulent situations. Includes new chapters on primary healthcare, secondary healthcare, information/data management and privacy, damages/risk management, and transparency Offers comprehensive guidance on auditing and fraud detection for healthcare providers and company healthcare plans Examines the necessary background that internal auditors should have when auditing healthcare activities Managing the risks in healthcare fraud requires an understanding of how the healthcare system works and where the key risk areas are. With health records now all being converted to electronic form, the key risk areas and audit process are changing. Read Healthcare Fraud, Second Edition and get the valuable guidance you need to help combat this critical problem.

License To Steal
License To Steal

Author: Malcolm K Sparrow

Publisher: Basic Books

Published: 2007-12-14

Total Pages: 306

ISBN-13: 0465010741

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Who steals? An extraordinary range of folk -- from low-life hoods who sign on as Medicare or Medicaid providers equipped with nothing more than beepers and mailboxes, to drug trafficking organizations, organized crime syndicates, and even major hospital chains. In License to Steal, Malcolm K. Sparrow shows how the industry's defenses, which focus mostly on finding and correcting billing errors, are no match for such well orchestrated attacks. The maxim for thieves simply becomes "bill your lies correctly." Provided they do that, fraud perpetrators with any degree of sophistication can steal millions of dollars with impunity, testing payment systems carefully, and then spreading fraudulent billings widely enough across patient and provider accounts to escape detection. The kinds of highly automated, quality controlled claims processing systems that pervade the industry present fraud perpetrators with their favorite kind of target: rich, fast paying, transparent, utterly predictable check printing systems, with little threat of human intervention, and with the U.S. Treasury on the end of the electronic line. Sparrow picks apart the industry's response to the government's efforts to control this problem. The provider associations (well heeled and politically influential) have vociferously opposed almost every recent enforcement initiative, creating the unfortunate public impression that the entire health care industry is against effective fraud control. A significant segment of the industry, it seems, regards fraud and abuse not as a problem, but as a lucrative enterprise worth defending. Meanwhile, it remains a perfectly commonplace experience for patients or their relatives to examine a medical bill and discover that half of it never happened, or that; likewise, if patients then complain, they discover that no one seems to care, or that no one has the resources to do anything about it. Sparrow's research suggests that the growth of capitated managed care systems does not solve the problem, as many in the industry had assumed, but merely changes its form. The managed care environment produces scams involving underutilization, and the withholding of medical care schemes that are harder to uncover and investigate, and much more dangerous to human health. Having worked extensively with federal and state officials since the appearance of his first book on this subject, Sparrow is in a unique position to evaluate recent law enforcement initiatives. He admits the "war on fraud" is at least now engaged, but it is far from won.