Legal enforcement of ethics in health care: regulation of antitrust

There are various forms of fraud that can be committed in a health care setting. Fraud not only impacts funding organizations—typically the federal government and consequently, the taxpayers—but also can have an impact on the quality of care delivered to individuals. This Case Assignment examines health care fraud, the penalties that are associated with fraud cases, and the role of Corporate Compliance Programs as a deterrent for fraud within health care organizations. 

Case Assignment

New Orleans woman sentenced to prison for role in $3.2 million health care fraud and kickback scheme. (2018). Retrieved from https://www.justice.gov/usao-edla/pr/new-orleans-woman-sentenced-prison-role-32-million-health-care-fraud-and-kickback

Sixteen individuals charged in $60 million Medicare fraud scheme. (2017). Retrieved from https://www.justice.gov/usao-ndtx/pr/sixteen-individuals-charged-60-million-medicare-fraud-scheme

Miami-Dade psychiatrist sentenced to prison for his participation in various fraud schemes. (2016). Retrieved from https://www.justice.gov/usao-sdfl/pr/miami-dade-psychiatrist-sentenced-prison-his-participation-various-fraud-schemes

For this module’s Case Assignment, choose one of the cases of Medicare or Medicaid fraud listed above. Discuss the elements of the case and the decision that was reached by the court; and identify the type(s) of fraud and the law/s that was/were broken. Analyze the penalty for the perpetrator and whether the outcome was appropriate.

Discuss how a Corporate Compliance Program can help minimize the risk of fraud for a health care organization.

You may research to find additional information on each case, as well as for general purposes for this assignment, but be sure to use only reliable sources 

Assignment Expectations

  1. Conduct additional research to gather sufficient information to justify/support your report.
  2. Limit your response to a maximum of 3 pages (title and reference page is not included in page number count).
  3. Support your paper with peer-reviewed articles, with at least 3 references. Use the following link for additional information on how to recognize peer-reviewed journals:
    Angelo State University Library. (n.d.). Library guides: How to recognize peer-reviewed (refereed) journals. Retrieved from https://www.angelo.edu/services/library/handouts/peerrev.php
  4. You may use the following source to assist in formatting your assignment:
    Purdue Online Writing Lab. (n.d.). General APA guidelines. Retrieved from https://owl.english.purdue.edu/owl/resource/560/01/
  5. For additional information on reliability of sources, review the following source:
    Georgetown University Library. (n.d.). Evaluating internet resources. Retrieved from https://www.library.georgetown.edu/tutorials/research-guides/evaluating-internet-content
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