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Profiteering, Corruption and Fraud in U.S. Health Care

Profiteering, Corruption and Fraud in U.S. Health Care
Author:
Publisher:
Total Pages: 206
Release: 2020-06
Genre:
ISBN: 9781938218279

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Profiteering, corruption and fraud are emblematic of our profit-driven, corporatized marketplace and so-called health care system. The three bleed into each other in an entangled way, and they are even increasing. We have to ask and answer: who is the health care system for- profits for health care corporations, their shareholders, and Wall Street traders and investors? for the corrupt and fraudulent scammers? or for patients, their families, and taxpayers? The urgent need for health care reform is at an all-time high as the U. S. struggles to deal with the COVID-19 pandemic and the recession certain to follow. We are far behind other advanced nations with one or another system of universal coverage. Incremental attempts to reform U. S. health care have failed for many years. Our broken system is no longer affordable for patients, families, and taxpayers. This book updates where we are with the untenable status quo and compares three major alternatives for reform-building on the ACA, the public option, and Medicare for All.


Trillion Dollar Scam

Trillion Dollar Scam
Author: Saul William Seidman
Publisher: Universal-Publishers
Total Pages: 200
Release: 2008
Genre: Business & Economics
ISBN: 159942956X

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Fraud is the result of government and insurance company control of health care. The growth of bureaucracy is a precursor to incompetence and soaring costs of medical care. A lack of clinical diagnosis and a dependence on expensive testing has increased costs while decreasing the doctor's competence. The FBI and the attorneys general of all states are dealing with exploding health care fraud. The result is a trillion dollars in waste and deception. Trillion Dollar Scam details the origin of this fraud and waste, and offers solutions to fixing the broken U.S. health care system.


The Profit Motive and Patient Care

The Profit Motive and Patient Care
Author: Bradford H. Gray
Publisher: Harvard University Press
Total Pages: 460
Release: 1991
Genre: Economics, Hospital
ISBN: 9780674713383

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In this penetrating analysis, Bradford Gray tackles the thorny issues surrounding the question of to whom and for what our physicians and hospitals are accountable. This book provides a careful evaluation of the mechanisms of accountability that have developed along with a growing profit orientation of health care, and it alerts us to keep a sharp eye focused on who is looking out for the interests of the patient.


Undercover

Undercover
Author: John W. Schilling
Publisher: Author House
Total Pages: 306
Release: 2010-09-24
Genre: Biography & Autobiography
ISBN: 1452055092

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When John Schilling, an unassuming midlevel accountant, joined Columbia Healthcare Corporation -- the nation's fastest growing and revolutionary network of public hospitals -- it seemed like the start of an exciting new career with great advancement and earnings potential. He never expected to become a catalyst for the series of "whistleblower" lawsuits that ripped through the healthcare industry in the late 1990s In Undercover, John Schilling tells the story of his harrowing journey from ordinary citizen and loyal employee to covert FBI informant and top witness for the Justice Department in the largest criminal healthcare fraud case in U.S. history. It began when he stumbled upon evidence-- a $3.5 million accounting "error"--of his company's routine practice of defrauding Medicare. When pressured to comply with stealing from taxpayers, Schilling knew he had to speak up for what he believed was right, regardless of the cost to his job, his reputation, and his family. His courageous choice would consume the next seven years of his life, leading to more drama, angst, turmoil, and money than he could have imagined. Ultimately, Schilling's moral conviction and a little known law, the False Claims Act, paid off by forcing the formidable healthcare conglomerate of Columbia/HCA to pay back $1.7 billion to the federal government. Revealing the personal side of a thankless role, Undercover is a gripping and inspiring account of a long, hard, life-- changing quest for justice. ADVANCE PRAISE FOR UNDERCOVER "Undercover crackles with authenticity as it recounts in a lively, readable style how a man on the inside risked everything and blew the whistle on a giant healthcare company that was systematically looting the Medicare program out of billions. A good read for anyone, but a must-read for someone who may contemplate taking the same path as John Schilling" -- John R. Phillips, "The nation's premier whistleblowing attorney" according to the The Wall Street Journal and the National Law Journal "John Schilling's book is a must-read for whistleblowers. He shows you how hard it can be, yet also shows you how to prevail. Best of all, John shows you how to be a good citizen" -- Jim Moorman, past President, Taxpayers Against Fraud


Health Care Fraud and Abuse

Health Care Fraud and Abuse
Author: Linda A. Baumann
Publisher: Bureau of National Affairs (BNA)
Total Pages: 0
Release: 2013
Genre: Health insurance
ISBN: 9781617463013

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Catastrophic Care

Catastrophic Care
Author: David Goldhill
Publisher: Vintage
Total Pages: 386
Release: 2013-01-08
Genre: Medical
ISBN: 0307961559

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A visionary investigation that will change the way we think about health care: how and why it is failing, why expanding coverage will actually make things worse, and how our health care can be transformed into a transparent, affordable, successful system. In 2007, David Goldhill’s father died from infections acquired in a hospital, one of more than two hundred thousand avoidable deaths per year caused by medical error. The bill was enormous—and Medicare paid it. These circumstances left Goldhill angry and determined to understand how world-class technology and personnel could coexist with such carelessness—and how a business that failed so miserably could be paid in full. Catastrophic Care is the eye-opening result. Blending personal anecdotes and extensive research, Goldhill presents us with cogent, biting analysis that challenges the basic preconceptions that have shaped our thinking for decades. Contrasting the Island of health care with the Mainland of our economy, he demonstrates that high costs, excess medicine, terrible service, and medical error are the inevitable consequences of our insurance-based system. He explains why policy efforts to fix these problems have invariably produced perverse results, and how the new Affordable Care Act is more likely to deepen than to solve these issues. Goldhill steps outside the incremental and wonkish debates to question the conventional wisdom blinding us to more fundamental issues. He proposes a comprehensive new way, where the customer (the patient) is first—a system focused on health and maintaining it, a system strong and vibrant enough for our future. If you think health care is interesting only to institutes and politicians, think again: Catastrophic Care is surprising, engaging, and brimming with insights born of questions nobody has thought to ask. Above all it is a book of new ideas that can transform the way we understand a subject we often take for granted.


Crossing the Global Quality Chasm

Crossing the Global Quality Chasm
Author: National Academies of Sciences, Engineering, and Medicine
Publisher: National Academies Press
Total Pages: 399
Release: 2019-01-27
Genre: Medical
ISBN: 0309477891

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In 2015, building on the advances of the Millennium Development Goals, the United Nations adopted Sustainable Development Goals that include an explicit commitment to achieve universal health coverage by 2030. However, enormous gaps remain between what is achievable in human health and where global health stands today, and progress has been both incomplete and unevenly distributed. In order to meet this goal, a deliberate and comprehensive effort is needed to improve the quality of health care services globally. Crossing the Global Quality Chasm: Improving Health Care Worldwide focuses on one particular shortfall in health care affecting global populations: defects in the quality of care. This study reviews the available evidence on the quality of care worldwide and makes recommendations to improve health care quality globally while expanding access to preventive and therapeutic services, with a focus in low-resource areas. Crossing the Global Quality Chasm emphasizes the organization and delivery of safe and effective care at the patient/provider interface. This study explores issues of access to services and commodities, effectiveness, safety, efficiency, and equity. Focusing on front line service delivery that can directly impact health outcomes for individuals and populations, this book will be an essential guide for key stakeholders, governments, donors, health systems, and others involved in health care.


Fraud and Corruption

Fraud and Corruption
Author: Peter C. Kratcoski
Publisher: Springer
Total Pages: 301
Release: 2018-09-14
Genre: Social Science
ISBN: 3319923331

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This textbook provides an overview of the major types of fraud and corrupt activities found in private and public agencies, as well as the various methods used to prevent fraud and corruption. It explores where opportunities for fraud exist, the personal characteristics of those who engage in fraud, as well as their prevention and control. This work covers fraud in the financial sector, insurance, health care, and police organizations, as well as cybercrime. It covers the relationship between fraud, corruption, and terrorism; criminal networks; and major types of personal scams (like identity theft and phishing). Finally, it covers the prevention and control of fraud, through corporate whistle blowing, investigative reporting, forensic accounting, and educating the public. This work will be of interest to graduate-level students (as well as upper-level undergraduates) in Criminology & Criminal Justice, particularly with a focus on white collar and corporate crime, as well as related fields like business and management.


The Battle Over Health Care

The Battle Over Health Care
Author: Rosemary Gibson
Publisher: Rowman & Littlefield Publishers
Total Pages: 233
Release: 2012-04-08
Genre: Health & Fitness
ISBN: 1442214511

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As the most substantial health care reform in almost half a century, President Obama's health care overhaul was as historic as it was divisive. In its aftermath, the debate continues. Drawing on decades of experience in health care policy, health care delivery reform, and economics, Rosemary Gibson and Janardan Prasad Singh provide a non-partisan analysis of the reform and what it means for America and its future. The authors shine a light on truths that have been hidden behind a raucous debate marred by political correctness on both sides of the aisle. They show how health care reform was enacted only with the consent of health insurance companies, drug firms, device manufacturers, hospitals, and other special interests that comprise the medical-industrial complex, which gained millions of new customers with the stroke of a pen. Health care businesses in a market-oriented system are designed to generate revenue, which runs counter to affordable health care. Gibson and Singh take a broader perspective on health care reform not as a single issue but as part of the economic life of the nation. The national debate unfolded while the banking and financial system teetered on the brink of collapse. The authors trace uncanny similarities between the health care industry and the unfettered banking and financial sector. They argue that a fast-changing global economy will have profound implications for the country's economic security and the jobs and health care benefits that come with it, and they predict that global competition will shape the future of employer-provided insurance more than the health care reform law.