1. As you try to understand the fact that tens of billions of dollars are lost to fraud, is it the number that is troublesome or the fact that nobody can agree on an estimate? What is being done and can be done to reduce fraud and prevent it?
2. You are the new compliance manager for a health care organization. Describe the steps you will take to ensure that your compliance plan is legal and effective.
3. A physician and his colleague decide to set up a laboratory owned by a dummy corporation in their wives’ names and begin to refer patients to this laboratory. What (if any) laws have they violated?
4. A psychiatrist bills for 10 hours of psychotherapy and medication checks for a deceased woman. Has he committed fraud or abuse? Can the deceased woman’s estate press charges if the bills were sent to Medicare, and not to the family?
5. An attorney sees a plastic surgeon and is so happy with her face-lift that she begins to refer all her friends and family. At her 6-month follow-up, she says, “So, Doc, I’ve sent you all these patients, where’s my 30% cut of your fees?” What should the plastic surgeon do?
6. While working on your homework for this course and surfing the Internet to check out all the fascinating links, you realize the person who manages the branch of the new durable medical equipment company (DMExcellence) where you work looks just like someone on the OIG Most Wanted list. He even has the same first name! And he has a wife who looks like the woman on the list with him! While you really need this new job to help pay your way through school, you have a sinking feeling all is not good at DMExcellence. What do you do?