...Medicare Fraud: The History, Incidence, Costs and Institutional Remedies INTRODUCTION In 1965, President Lyndon B. Johnson signed the Medicare Act into law. The purpose was to provide healthcare to individuals the age of 65 or older or individuals under the age of 65 diagnosed with specific medical conditions (Center for Medicare and Medicaid Services, 2013). The original intent was to provide immediate payment to those providing medical services for the less fortunate. The Medicare Act has since been revised to meet the current needs of the American population as well as the United States economy. In part, these revisions included identifying, combating, establishing punishment (criminal laws) and prevention for Medicare Fraud. This paper will provide a brief overview of the Medicare fraud history, incidence, costs and institutional remedies. MEDICARE FRAUD: HISTORY AND DEFINITION Fraudulent activities against the government were first addressed during the Civil War. The False Claims Act (qui tam statute), also known as the Lincoln Act, was passed during this time frame. The intent was to prevent the Union Army from being a victim of supplier fraud. Citizens were given, “the ability to file suits on behalf of the US government whenever they spotted fraud” (Medicare Fraud Center, 2015). The citizens were rewarded with a portion of the monetary fines (issued to the defendant) for addressing the crime. Currently, similar rewards remain in effect for reporting Medicare...
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...Medicare Fraud: The History, Incidence, Costs and Institutional Remedies John H Everett Wayland Baptist Medicare Fraud: The History, Incidence, Costs and Institutional Remedies What is Medicare fraud? ("F&A," 2011, p. 1) states “Medicare fraud happens when Medicare is billed for services or supplies you never got. Medicare fraud costs Medicare a lot of money each year.” What is Medicare abuse? ("F&A," 2011, p. 1) defines this as “Abuse occurs when doctors or suppliers don’t follow good medical practices, resulting in unnecessary costs to Medicare, improper payment, or services that aren’t medically necessary.” In reviewing the definitions of fraud and abuse by Medicare it may be hard for some people to understand if they do not live in the healthcare world daily. In an effort to help shed some light on this, we will look at the history of Medicare fraud. It has been around since the Civil War, when the False Claims Act (FCA) was created. It was also called the Qui Tam Statue meaning “he who sues for the king as himself.” ("FCA," 2011, p. 1) “The law was targeted at stopping dishonest suppliers to the military Union military at a time when the war effort made it all but impossible for the government to investigate and prosecute the fraud itself. Today it serves a similar purpose because of the enormous size of the federal government and the variety or programs under which it expends taxpayer funds.” In 1986 the FCA has been revised over the...
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...More Than a Numbers Game A Brief Histor y of Accounting Thomas A. King John Wiley & Sons, Inc. More Than a Numbers Game More Than a Numbers Game A Brief Histor y of Accounting Thomas A. King John Wiley & Sons, Inc. Copyright © 2006 by Thomas A. King. All rights reserved. Published by John Wiley & Sons, Inc., Hoboken, New Jersey. Published simultaneously in Canada. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning, or otherwise, except as permitted under Section 107 or 108 of the 1976 United States Copyright Act, without either the prior written permission of the Publisher, or authorization through payment of the appropriate per-copy fee to the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, (978) 750-8400, fax (978) 646-8600, or on the web at www.copyright.com. Requests to the Publisher for permission should be addressed to the Permissions Department, John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, (201) 748-6011, fax (201) 748-6008, or online at http://www.wiley.com/go/permissions. Limit of Liability/Disclaimer of Warranty: While the publisher and author have used their best efforts in preparing this book, they make no representations or warranties with respect to the accuracy or completeness of the contents of this book and specifically disclaim any implied warranties of merchantability...
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...NOT FOR DISTRIBUTION: USE ONLY IN COMPLIANCE WITH COPYRIGHT: DAVID RISSTROM AN INTERPRETATION OF LAW IN CONTEXT Bottomley, S., Gunningham, N. and Parker, S., 1991, Law in Context, The Federation Press, Leichhardt. { } = additional material from lectures. ( ) = my comments. (See ‘x’) refers to book page number. A short (somewhat boring) message from the summary executioner before you dive in; These notes are an interpretation of the book Law in Context and the lectures given as part of the 1991 Course. They are not a satisfactory substitution for reading the text. You are only likely to get the maximum value out of this summary by reading it in conjunction with the text. The question of ‘the law in whose context’ may be worth keeping in mind as you read. This is an interpretation seen through my eyes, not yours. My comments are not unbiased, as it is as equally unlikely that yours may be. So my ‘advice’ is consider what is said here and in the book considering the need to understand the ‘mechanics’ that help make sense of the more involved themes that develop in the book as you progress through Law in Context. The observations, important in their own right, may be particularly useful for seeing how their often ubiquitous expression is taken as ‘normal’ in the areas of wider society, such as in discussions of economics and power. It is unlikely that you will find any ‘right answers’ from this summary, but I do hope it helps you in synthesising...
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...ETHICS IN INFORMATION TECHNOLOGY Third Edition This page intentionally left blank ETHICS IN INFORMATION TECHNOLOGY Third Edition George W. Reynolds Australia • Brazil • Japan • Korea • Mexico • Singapore • Spain • United Kingdom • United States Ethics in Information Technology, Third Edition by George W. Reynolds VP/Editorial Director: Jack Calhoun Publisher: Joe Sabatino Senior Acquisitions Editor: Charles McCormick Jr. Senior Product Manager: Kate Hennessy Mason Development Editor: Mary Pat Shaffer Editorial Assistant: Nora Heink Marketing Manager: Bryant Chrzan Marketing Coordinator: Suellen Ruttkay Content Product Manager: Jennifer Feltri Senior Art Director: Stacy Jenkins Shirley Cover Designer: Itzhack Shelomi Cover Image: iStock Images Technology Project Manager: Chris Valentine Manufacturing Coordinator: Julio Esperas Copyeditor: Green Pen Quality Assurance Proofreader: Suzanne Huizenga Indexer: Alexandra Nickerson Composition: Pre-Press PMG © 2010 Course Technology, Cengage Learning ALL RIGHTS RESERVED. No part of this work covered by the copyright herein may be reproduced, transmitted, stored or used in any form or by any means graphic, electronic, or mechanical, including but not limited to photocopying, recording, scanning, digitizing, taping, Web distribution, information networks, or information storage and retrieval systems, except as permitted under Section 107 or 108 of the 1976 United States Copyright Act, without the prior written permission...
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...Private expenditure — Need for financial protection. Chapter 3 – Health Insurance in India Development of Insurance in India—Evolution of Health Insurance in India— Current Perspective. Chapter 4 – Need For Reforms In Health Insurance Existing Regulatory provisions- Need for Reforms from the Senior Citizens’ perspective Chapter 5 - Access To Health Insurance For Senior Citizens Products currently available for Senior Citizens—Underwriting practices of insurers—Affordability and accessibility Chapter 6- Product Design Proper product design—Design mechanisms: Insured persons; Providers; Insurers --- Basic, Standard, Enhanced products—Policy clauses—Health Insurance data—The ‘age’ factor— Overseas Travel Insurance— Government Subsidized and Low Cost Health Insurance Plans for Senior Citizens---Recommendations. Chapter 7– Risk Based Underwriting And Pricing Pricing adequacy and equity—Pricing of the mandatory cover for Senior Citizens—Underwriting based on health status-Affordability -Recommendations. Chapter 8 - Expanding The Coverage Of Health Insurance Socio-economic scenario in India—Penetration of Health Insurance in India—Health insurance for the elderly—Reaching out to Senior Citizens; Reaching the Elderly through Family clinicsRecommendations. Chapter 9 - Procedural Aspects Chapter 10 - Government Intervention Chapter 11 - Role Of Insurance Regulatory And Development Authority Chapter 12 – Summary of Recommendations Chapter 13 - Terms Of Reference (TOR) And Methodology Adopted...
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...Handbook of Management Accounting Research Volume 3 Edited by CHRISTOPHER S. CHAPMAN Imperial College London, UK ANTHONY G. HOPWOOD University of Oxford, UK MICHAEL D. SHIELDS Michigan State University, USA AMSTERDAM – BOSTON – HEIDELBERG – LONDON – NEW YORK – OXFORD PARIS – SAN DIEGO – SAN FRANCISCO – SINGAPORE – SYDNEY – TOKYO Elsevier The Boulevard, Langford Lane, Kidlington, Oxford OX5 1GB, UK First edition 2009 Copyright © 2009 Elsevier Ltd. All rights reserved No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means electronic, mechanical, photocopying, recording or otherwise without the prior written permission of the publisher Permissions may be sought directly from Elsevier’s Science & Technology Rights Department in Oxford, UK: phone ( 44) (0) 1865 843830; fax ( 44) (0) 1865 853333; email: permissions@elsevier.com. Alternatively visit the Science and Technology Books website at www.elsevierdirect.com/rights for further information Notice No responsibility is assumed by the publisher for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions or ideas contained in the material herein. British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging-in-Publication Data A catalog record for...
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...Parliament of Australia Department of Parliamentary Services Parliamentary Library Information, analysis and advice for the Parliament RESEARCH PAPER www.aph.gov.au/library 26 May 2010, no. 17, 2009–10, ISSN 1834-9854 Budget Review 2010–11 Last year’s Budget was framed amid a sharply deteriorating world economy which was considered the most challenging global economic conditions since the Great Depression. In 2009, the global economy contracted for the first time in the post-war era. In contrast, Australia grew by almost 1.5 per cent supported by monetary and fiscal policy stimulus, a well-functioning banking system, and strong growth in a number of East Asian economies. The third Rudd Government Budget, presented on 11 May 2010, was developed within an improving but still uncertain outlook, with events in Greece and other European Union countries reminding us of the risks to the global economic recovery. Strong economic growth in China and India is expected to continue to flow throughout the region and, despite a slower pace, the US is leading the recovery among our advanced economy major trading partners. Global economic growth is in the early stages of recovery but we should remain cognisant of the precarious economic environment which is continuing to challenge government policy makers around the globe. Once again the Parliamentary Library has produced the annual Budget Review that examines the key features of a selection of crucial measures contained...
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...Annual Report 2008-09 Productivity Commission Annual Report Series © COMMONWEALTH OF AUSTRALIA 2009 ISSN ISBN 978-1-74037-286-2 1035-5243 This work is subject to copyright. Apart from any use as permitted under the Copyright Act 1968, the work may be reproduced in whole or in part for study or training purposes, subject to the inclusion of an acknowledgment of the source. Reproduction for commercial use or sale requires prior written permission from the Attorney-General’s Department. Requests and inquiries concerning reproduction and rights should be addressed to the Commonwealth Copyright Administration, Attorney-General’s Department, Robert Garran Offices, National Circuit, Canberra ACT 2600. This publication is available in hard copy or PDF format from the Productivity Commission website at www.pc.gov.au. If you require part or all of this publication in a different format, please contact Media and Publications (see below). Publications Inquiries: Media and Publications Productivity Commission Locked Bag 2 Collins Street East Melbourne VIC 8003 Tel: Fax: Email: (03) 9653 2244 (03) 9653 2303 maps@pc.gov.au General Inquiries: Tel: (03) 9653 2100 or (02) 6240 3200 An appropriate citation for this paper is: Productivity Commission 2009, Annual Report 2008-09, Annual Report Series, Productivity Commission, Canberra JEL code: D The Productivity Commission The Productivity Commission, is the Australian Government’s independent research and advisory body on a range...
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...HOW CAPITALISM WILL SAVE US Why Free People and Free Markets Are the Best Answer is Today's Economy S T E V E FORBES and E L I Z A B E T H A M E S HOW CAPITALISM WILL SAVE US HOW CAPITALISM WILL SAVE US W h y Free People and Free Markets A r e t h e Best A n s w e r i n Today's E c o n o m y Steve Forbes AND ELIZABETH AMES CROWN BUSINESS ALSO BY STEVE FORBES Power Ambition Glory (coauthored with John Prevas) Flat Tax Revolution A New Birth of Freedom To the millions of individuals whose energy, innovation, and resilience built the Real World economy. Their enterprise, when unleashed, is always the answer. Copyright © 2009 by Steve Forbes and Elizabeth Ames All rights reserved. Published in the United States by Crown Business, an imprint of the Crown Publishing Group, a division of Random House, Inc., New York. www.crownpublishing.com CROWN BUSINESS is a trademark and CROWN and the Rising Sun colophon are registered trademarks of Random House, Inc. Library of Congress Cataloging-in-Publication Data Forbes, Steve, 1947How capitalism will save us / Steve Forbes and Elizabeth Ames.—1st ed. p. cm. Includes index. 1. Capitalism—United States. 2. United States—Economic policy. 3. United States—Economic conditions. I. Ames, Elizabeth. II. Title. HB501.F646 2009 330.12'20973—dc22 2009032751 ISBN 978-0-307-46309-8 Printed in the United States of America DESIGN BY BARBARA S T U R M A N 1O 9 8 7...
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...Economics Harvard University Cambridge, Massachusetts May 1992 Abstract Chapter I: Adverse selection in an insurance market may result in low-risk individuals remaining uncovered. In the framework of a monopolistic insurance market with private information, it is shown that government entry to the market as a competitor which sells insurance, results in all potential buyers actually purchasing insurance. Chapter II: The welfare trade off between reduction in risk and enhanced market power, as depository institutions become larger but fewer, is studied. The main result is that when there are enough independent risks in the economy, it is possible to achieve high diversification through mergers between depository institutions at a very small cost in terms of greater market power. Chapter III: Firms wishing to issue securities on the stock market are required to disclose private information which might be beneficial to competitors. Issuing securities publicly is more costly than doing so privately. In equilibrium, firms with sensitive information issue securities privately, while competitors cannot unambiguously infer that the information withheld is very sensitive. This suggests that one special role of banks and venture capital in financial markets, is to provide debt and equity financing, respectively, confidentially. Chapter IV: A decentralized market with pairwise meetings of agents is studied. There is a one sided information asymmetry regarding the state of the world, which may be...
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...12:06 Page 1 WOMEN, GENDER AND WORK People are not defined solely by their work, nor is it possible to ignore the effects of factors outside the workplace on a person's status at work. To seek equality at work without seeking equality in the larger society – and at home – is illusory.Thus an examination of the issues surrounding women, gender and work must be holistic. That means considering the role of productive work in life as a whole and the distribution of unpaid work as well as the myriad questions relating to employment. This important anthology brings together the thinking of leading philosophers, economists and lawyers on this complex subject. Selected recent articles from the multidisciplinary International Labour Review are assembled for the first time to illuminate questions such as how we should define equality, what equal opportunity means and what statistics tell us about differences between men and women at work, how the family confronts globalization and what is the role of law in achieving equality. There is an examination of policy – to deal with sexual harassment and wage inequality, for example, as well as part-time work, the glass ceiling, social security, and much more. A major reference on the best of current research and analysis on gender roles and work. Martha Fetherolf Loutfi has been Editor-in-Chief of the International Labour Review, a Senior Economist for the Brandt Commission and in the ILO’s Employment and Development...
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...Learning with Cases INTRODUCTION The case study method of teaching used in management education is quite different from most of the methods of teaching used at the school and undergraduate course levels. Unlike traditional lecture-based teaching where student participation in the classroom is minimal, the case method is an active learning method, which requires participation and involvement from the student in the classroom. For students who have been exposed only to the traditional teaching methods, this calls for a major change in their approach to learning. This introduction is intended to provide students with some basic information about the case method, and guidelines about what they must do to gain the maximum benefit from the method. We begin by taking a brief look at what case studies are, and how they are used in the classroom. Then we discuss what the student needs to do to prepare for a class, and what she can expect during the case discussion. We also explain how student performance is evaluated in a case study based course. Finally, we describe the benefits a student of management can expect to gain through the use of the case method. WHAT IS A CASE STUDY? There is no universally accepted definition for a case study, and the case method means different things to different people. Consequently, all case studies are not structured similarly, and variations abound in terms of style, structure and approach. Case material ranges from small caselets (a few paragraphs...
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...___________________________ LIVING HISTORY Hillary Rodham Clinton Simon & Schuster New York • London • Toronto • Sydney • Singapore To my parents, my husband, my daughter and all the good souls around the world whose inspiration, prayers, support and love blessed my heart and sustained me in the years of living history. AUTHOR’S NOTE In 1959, I wrote my autobiography for an assignment in sixth grade. In twenty-nine pages, most half-filled with earnest scrawl, I described my parents, brothers, pets, house, hobbies, school, sports and plans for the future. Forty-two years later, I began writing another memoir, this one about the eight years I spent in the White House living history with Bill Clinton. I quickly realized that I couldn’t explain my life as First Lady without going back to the beginning―how I became the woman I was that first day I walked into the White House on January 20, 1993, to take on a new role and experiences that would test and transform me in unexpected ways. By the time I crossed the threshold of the White House, I had been shaped by my family upbringing, education, religious faith and all that I had learned before―as the daughter of a staunch conservative father and a more liberal mother, a student activist, an advocate for children, a lawyer, Bill’s wife and Chelsea’s mom. For each chapter, there were more ideas I wanted to discuss than space allowed; more people to include than could be named; more places visited than could be described...
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...IN THIS CHAPTER YOU WILL . . . 1 Learn that economics is about the allocation of scarce resources Examine some of the tradeof fs that people face Learn the meaning of oppor tunity cost See how to use marginal reasoning when making decisions TEN OF PRINCIPLES ECONOMICS Discuss how incentives af fect people’s behavior The word economy comes from the Greek word for “one who manages a household.” At first, this origin might seem peculiar. But, in fact, households and economies have much in common. A household faces many decisions. It must decide which members of the household do which tasks and what each member gets in return: Who cooks dinner? Who does the laundry? Who gets the extra dessert at dinner? Who gets to choose what TV show to watch? In short, the household must allocate its scarce resources among its various members, taking into account each member’s abilities, efforts, and desires. Like a household, a society faces many decisions. A society must decide what jobs will be done and who will do them. It needs some people to grow food, other people to make clothing, and still others to design computer software. Once society has allocated people (as well as land, buildings, and machines) to various jobs, 3 Consider why trade among people or nations can be good for everyone Discuss why markets are a good, but not per fect, way to allocate resources Learn what determines some trends in the overall economy 1 TLFeBOOK 2 4 Ten Principles...
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