Reasons for Disclosure in the Physician-Patient Relationship: How Physician Conduct and Reimbursement Methodologies Lead to Fraud and Abuse in Medicare PDF Download
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Author: Kathleen Johnson
Publisher: Universal-Publishers
ISBN: 1599423278
Category :
Languages : en
Pages :
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Book Description
The solvency of the Medicare Trust Fund has been debated for the past twenty-five years and despite various stop-gap measures, fraud and abuse continues. Public policy in the form of Stark legislation, anti-kickback laws, and false claims acts were enacted to reduce over-utilization of services and prohibit self-referral and inducements for patients and services. Despite public policy and continued prosecution of fraud, Medicare reimbursement methods fail to control physician conduct of over-utilization and inducements for referrals. Following the concept of the informed consent doctrine and the theory of fiduciary trust in the patient-physician relationship, it is the author's thesis that transparency and disclosure with respect to physician prescription and referral practices can mitigate the over-utilization problem.
Author: Kathleen Johnson
Publisher: Universal-Publishers
ISBN: 1599423278
Category :
Languages : en
Pages :
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Book Description
The solvency of the Medicare Trust Fund has been debated for the past twenty-five years and despite various stop-gap measures, fraud and abuse continues. Public policy in the form of Stark legislation, anti-kickback laws, and false claims acts were enacted to reduce over-utilization of services and prohibit self-referral and inducements for patients and services. Despite public policy and continued prosecution of fraud, Medicare reimbursement methods fail to control physician conduct of over-utilization and inducements for referrals. Following the concept of the informed consent doctrine and the theory of fiduciary trust in the patient-physician relationship, it is the author's thesis that transparency and disclosure with respect to physician prescription and referral practices can mitigate the over-utilization problem.
Author: Aspen Health Law Center
Publisher:
ISBN:
Category : Business & Economics
Languages : en
Pages : 156
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Book Description
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.
Author: Institute of Medicine
Publisher: National Academies Press
ISBN: 0309183618
Category : Medical
Languages : en
Pages : 261
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Book Description
Clinical laboratory tests play an integral role in helping physicians diagnose and treat patients. New developments in laboratory technology offer the prospect of improvements in diagnosis and care, but will place an increased burden on the payment system. Medicare, the federal program providing coverage of health-care services for the elderly and disabled, is the largest payer of clinical laboratory services. Originally designed in the early 1980s, Medicare's payment policy methodology for outpatient laboratory services has not evolved to take into account technology, market, and regulatory changes, and is now outdated. This report examines the current Medicare payment methodology for outpatient clinical laboratory services in the context of environmental and technological trends, evaluates payment policy alternatives, and makes recommendations to improve the system.
Author: Institute of Medicine
Publisher: National Academies Press
ISBN: 0309036437
Category : Medical
Languages : en
Pages : 580
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Book Description
"[This book is] the most authoritative assessment of the advantages and disadvantages of recent trends toward the commercialization of health care," says Robert Pear of The New York Times. This major study by the Institute of Medicine examines virtually all aspects of for-profit health care in the United States, including the quality and availability of health care, the cost of medical care, access to financial capital, implications for education and research, and the fiduciary role of the physician. In addition to the report, the book contains 15 papers by experts in the field of for-profit health care covering a broad range of topicsâ€"from trends in the growth of major investor-owned hospital companies to the ethical issues in for-profit health care. "The report makes a lasting contribution to the health policy literature." â€"Journal of Health Politics, Policy and Law.
Author: American College of Physicians (2003- ). Ethics and Human Rights Committee
Publisher: ACP Press
ISBN: 1930513658
Category : Medical ethics
Languages : en
Pages : 72
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Book Description
Examines the issues in medical ethics faced by doctors and their patients. This book also discusses the distinction and potential conflicts between legal and ethical obligations while making clinical decisions. It includes sections on: Genetic testing, Organ donation, Care of patients at the end of life, Health and human rights, and more.
Author: June Gibbs Brown
Publisher: DIANE Publishing
ISBN: 1437903223
Category : Health & Fitness
Languages : en
Pages : 25
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Book Description
Evaluates the Dept. of Health and Human Services¿ oversight of sponsor and investigator efforts to recruit human subjects for industry-sponsored clinical trials (CT). It focuses on industry-sponsored CT because in recent years industry sponsors have assumed a more prominent role in the search for new drugs. Sponsors and investigators are facing increasing difficulty finding enough subjects in a timely manner to bring drugs to market within their desired time-frame. This report explains the recruitment practices used in industry-sponsored CT for investigational drugs; identifies major concerns about them; and addresses the extent and type of oversight undertaken by institutional review boards and, the FDA, and the NIH.
Author:
Publisher:
ISBN: 9781683086857
Category :
Languages : en
Pages : 546
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Book Description
In addition to reprinting the PDF of the CMS CoPs and Interpretive Guidelines, we include key Survey and Certification memos that CMS has issued to announced changes to the emergency preparedness final rule, fire and smoke door annual testing requirements, survey team composition and investigation of complaints, infection control screenings, and legionella risk reduction.
Author: American Bar Association. House of Delegates
Publisher: American Bar Association
ISBN: 9781590318737
Category : Law
Languages : en
Pages : 216
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Book Description
The Model Rules of Professional Conduct provides an up-to-date resource for information on legal ethics. Federal, state and local courts in all jurisdictions look to the Rules for guidance in solving lawyer malpractice cases, disciplinary actions, disqualification issues, sanctions questions and much more. In this volume, black-letter Rules of Professional Conduct are followed by numbered Comments that explain each Rule's purpose and provide suggestions for its practical application. The Rules will help you identify proper conduct in a variety of given situations, review those instances where discretionary action is possible, and define the nature of the relationship between you and your clients, colleagues and the courts.
Author: Institute of Medicine
Publisher: National Academies Press
ISBN: 0309145449
Category : Medical
Languages : en
Pages : 436
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Book Description
Collaborations of physicians and researchers with industry can provide valuable benefits to society, particularly in the translation of basic scientific discoveries to new therapies and products. Recent reports and news stories have, however, documented disturbing examples of relationships and practices that put at risk the integrity of medical research, the objectivity of professional education, the quality of patient care, the soundness of clinical practice guidelines, and the public's trust in medicine. Conflict of Interest in Medical Research, Education, and Practice provides a comprehensive look at conflict of interest in medicine. It offers principles to inform the design of policies to identify, limit, and manage conflicts of interest without damaging constructive collaboration with industry. It calls for both short-term actions and long-term commitments by institutions and individuals, including leaders of academic medical centers, professional societies, patient advocacy groups, government agencies, and drug, device, and pharmaceutical companies. Failure of the medical community to take convincing action on conflicts of interest invites additional legislative or regulatory measures that may be overly broad or unduly burdensome. Conflict of Interest in Medical Research, Education, and Practice makes several recommendations for strengthening conflict of interest policies and curbing relationships that create risks with little benefit. The book will serve as an invaluable resource for individuals and organizations committed to high ethical standards in all realms of medicine.
Author: AMERICAN COLLEGE OF PHYSICIANS.
Publisher:
ISBN: 9781938921148
Category :
Languages : en
Pages :
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Book Description
