CHCAA some health care fraud cases

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CHCAA_Canada

www.chcaa.org

Health & Medicine News & Politics

Fraud Cases cont'd

Dr. jailed for trafficking pain
killers


Drug addicts a hit with
Vancouver pharmacy


Fake nurse defrauds insurers


Wanted Canadian doc tracked
to Newcastle, UK.

Some Case Studies

CBC TV Investigative report - dental

A woman from Brampton charged with 234
counts of double doctoring and fraud for
prescription narcotics

A pharmacist charged with obtaining
prescriptions for high priced drugs and paying
the patient a percentage of the total prescription
– not dispensing the meds however billing ON
Gov. for the prescription.

A US citizen charged who was receiving insured
medical services for which he was not entitled

Some Case Studies

Foot care practitioners charged with
submitting fraudulent claims to OHIP

A Pharmacy case – fake Norvasc
medication being dispensed to clients and
the coroner investigating if this
contributed to the deaths of multiple
patients

A Canadian pair who were charged over
their fake Cancer clinic – this affected
over 800 patients in Mexico totaling 12
million dollars

Contact Us

Canadian Health Care
A Anti-fraud Association (CHCAA)

www.chcaa.org
Phone 416-593-2633
e-mail info@chcaa.org

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Chapter 11 Hospital Departments & Allied Health Professionals LEARNING OBJECTIVES • Describe a variety of negligent errors by allied health professionals. • Discuss the purpose of certification, licensure, and reasons for revocation of licenses. • Describe helpful advice for caregivers. PROFESSIONAL ETHICS • Standards or codes of conduct by specific profession. • Created in response to actual or anticipated ethical conflicts. • Examples – Falsifying records – Sexual improprieties – Sharing confidential patient information Chiropractor • Standard of care required – degree of care, judgment, & skill exercised by other reasonable chiropractors under like or similar circumstances. Emergency Department • Objectives of Emergency Care – treatment must begin as rapidly as possible – function is to be maintained or restored – scarring & deformity are to be minimized – treatment regardless of ability to pay. Jury Returns Largest Medical Malpractice Verdict • A man arrived at the ER with severe neck pain and numbness in his arms and legs. A doctor diagnosed his condition as neck strain and released the man from the hospital. A few hours later, the man became completely paralyzed from the chest down… The jury awarded the plaintiff $15 million; $10 million of which was for non- economic damages. −Mark Bello, The Legal Examiner, December 30, 2012 No Duty to Patient Who Left ED Untreated • In a wrongful death medical malpractice action alleging negligence, the trial court properly granted summary judgment because under Ohio law, an emergency room nurse had no duty to interfere with an individual who left the ED without telling anyone and who refused treatment. −Griffith v. University Hospitals of Cleveland Failure to Admit • Physician was found negligent in failing to hospitalize the patient or failing to inform her of the serious nature of her illness. The trial court found that had the patient been hospitalized on her first visit, her chances of survival would have been increased. −Roy v. Gupta Documentation Sparse & Contradictory • ED physician failed to evaluate the patient & to initiate care within first few minutes of patient's entry into the emergency facility. The emergency physician had an obligation to determine who was waiting for physician care & how critical the need was for that care. −Fenney v. New England Medical Ctr. EMTALA – I • In 1986, Congress passed the Emergency Medical Treatment and Active Labor Act (EMTALA) that forbids Medicare-participating hospitals from dumping patients out of emergency departments. EMTALA 42 U.S.C.A. § 1395dd(a) (1992) • in the case of a hospital that has a hospital emergency department, if any individual (whether or not eligible for benefits under this subchapter) comes to the emergency department and a request is made on the individual's behalf for examination or treatment for a medical condition, the hosp.

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By Julie Creswell and Reed Abelson Nov. 30, 2012 For decades, doctors in picturesque Boise, Idaho, were part of a tight-knit community, freely referring patients to the specialists or hospitals of their choice and exchanging information about the latest medical treatments. But that began to change a few years ago, when the city’s largest hospital, St. Luke’s Health System, began rapidly buying physician practices all over town, from general practitioners to cardiologists to orthopedic surgeons. Today, Boise is a medical battleground. A little over half of the 1,400 doctors in southwestern Idaho are employed by St. Luke’s or its smaller competitor, St. Alphonsus Regional Medical Center. Many of the independent doctors complain that both hospitals, but especially St. Luke’s, have too much power over every aspect of the medical pipeline, dictating which tests and procedures to perform, how much to charge and which patients to admit. In interviews, they said their referrals from doctors now employed by St. Luke’s had dropped sharply, while patients, in many cases, were paying more there for the same level of treatment. Boise’s experience reflects a growing national trend toward consolidation. Across the country, doctors who sold their practices and signed on as employees have similar criticisms. In lawsuits and interviews, they describe growing pressure to meet the financial goals of their new employers — often by performing unnecessary tests and procedures or by admitting patients who do not need a hospital stay. In Boise, just a few weeks ago, even the hospitals were at war. St. Alphonsus went to court seeking an injunction to stop St. Luke’s from buying another physician practice group, arguing that the hospital’s dominance in the market was enabling it to drive up prices and to demand exclusive or preferential agreements with insurers. The price of a colonoscopy has quadrupled in some instances, and in other cases St. Luke’s charges nearly three times as much for laboratory work as nearby facilities, according to the St. Alphonsus complaint. Federal and state officials have also joined the fray. In one of a handful of similar cases, the Federal Trade Commission and the Idaho attorney general are investigating whether St. Luke’s has become too powerful in Boise, using its newfound leverage to stifle competition. Dr. David C. Pate, chief executive of St. Luke’s, denied the assertions by St. Alphonsus that the hospital’s acquisitions had limited patient choice or always resulted in higher prices. In some cases, Dr. Pate said, services that had been underpriced were raised to reflect market value. St. Luke’s, he argued, is simply embracing the new model of health care, which he predicted would lead over the long term to lower overall costs as fewer unnecessary tests and procedures were performed. Regulators expressed some skepticism about the results, for patients, of rapid consolidation, although the trend is still too new to know fo ...

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1. What was the reasoning for enacting the EMTALA? 2. Should medical advice be dispensed on the telephone? Explain your opinion. 3. Discuss why you think the prescribing, control, administration, and monitoring of medications has become a major area of legal concern for health care professionals. 4. Describe the difference between the certification and licensing of a health care professional. 1. Describe the organization, responsibilities, duties, and legal risks of a governing body. 2. List some of the major provisions of SOX 3. Describe the meaning of the legal doctrine respondeat superior. 4. Describe the term corporate negligence. 5. Why is the Darling case described as a benchmark case? 6. Does the legal doctrine respondeat superior apply to an independent contractor? Explain your answer. Chapter 11 Hospital Departments & Allied Health Professionals LEARNING OBJECTIVESDescribe a variety of negligent errors by allied health professionals.Discuss the purpose of certification, licensure, and reasons for revocation of licenses.Describe helpful advice for caregivers. PROFESSIONAL ETHICS Standards or codes of conduct by specific profession. Created in response to actual or anticipated ethical conflicts.ExamplesFalsifying recordsSexual improprietiesSharing confidential patient information ChiropractorStandard of care requireddegree of care, judgment, & skill exercised by other reasonable chiropractors under like or similar circumstances. Emergency DepartmentObjectives of Emergency Caretreatment must begin as rapidly as possiblefunction is to be maintained or restoredscarring & deformity are to be minimizedtreatment regardless of ability to pay. Jury Returns Largest Medical Malpractice Verdict A man arrived at the ER with severe neck pain and numbness in his arms and legs. A doctor diagnosed his condition as neck strain and released the man from the hospital. A few hours later, the man became completely paralyzed from the chest down… The jury awarded the plaintiff $15 million; $10 million of which was for non-economic damages. −Mark Bello, The Legal Examiner, December 30, 2012 No Duty to Patient Who Left ED UntreatedIn a wrongful death medical malpractice action alleging negligence, the trial court properly granted summary judgment because under Ohio law, an emergency room nurse had no duty to interfere with an individual who left the ED without telling anyone and who refused treatment. −Griffith v. University Hospitals of Cleveland Failure to AdmitPhysician was found negligent in failing to hospitalize the patient or failing to inform her of the serious nature of her illness. The trial court found that had the patient been hospitalized on her first visit, her chances of survival would have been increased. −Roy v. Gupta Documentation Sparse & ContradictoryED physician failed to evaluate the patient & to initiate care within first few minutes of patient's entry into the emergency facility. The e ...

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In this captivating lecture, Dr. Faiza, an esteemed Assistant Professor of Physiology, embarks on a comprehensive journey into the multifaceted realm of local blood flow regulation. With meticulous detail and clarity, she unravels the intricate mechanisms that govern the dynamic balance between tissue perfusion and vascular resistance, shedding light on both acute and chronic aspects of blood flow control. Beginning with an exploration of acute influences, Dr. Faiza elucidates how physiological factors such as metabolic demand, myogenic responses, and autoregulatory mechanisms orchestrate rapid adjustments in local blood flow. Students gain insight into the vasodilator theory, which elucidates the role of metabolic byproducts and vasoactive metabolites in promoting vasodilation, alongside the oxygen demand theory, which underscores the interplay between tissue oxygenation and nutrient demand. Delving deeper, the lecture delves into the fascinating realm of humoral control, where hormones and vasoactive substances wield significant influence over vascular tone. Dr. Faiza navigates through the intricacies of endothelial-derived factors like nitric oxide (NO) and histamine, alongside hormonal regulators such as angiotensin II and vasopressin. Through vivid explanations and illustrative examples, she unveils the intricate dance of vasodilation and vasoconstriction orchestrated by these biochemical messengers. Moreover, the lecture extends its gaze to the extrinsic control of blood flow, where sympathetic innervation exerts a profound impact on vascular dynamics. Dr. Faiza elucidates the role of sympathetic tone in modulating vascular resistance, highlighting its implications in diverse physiological and pathological scenarios. From skin perfusion to coronary circulation, students gain a nuanced understanding of how neural inputs shape local blood flow patterns. Enriched with clinical insights and contemporary research findings, this lecture equips students with a holistic understanding of blood flow regulation. By exploring concepts like active and reactive hyperemia, vascular remodeling, and collateral circulation, Dr. Faiza fosters a deeper appreciation for the adaptive responses of the cardiovascular system to changing physiological demands and pathological insults.

Control of Local Blood Flow: acute and chronic

MedicoseAcademics

Step into the captivating realm of cardiovascular physiology as Dr. Faiza, an esteemed Assistant Professor of Physiology, unravels the intricacies of recording an electrocardiogram (ECG). In this illuminating lecture, students are guided through the fundamental principles of ECG interpretation, from lead systems and electrode placement to the analysis of waves, segments, and intervals. Beginning with an exploration of the twelve-lead system, Dr. Faiza elucidates the significance of bipolar limb leads (I, II, III), unipolar limb leads (aVR, aVL, aVF), and unipolar chest leads (V1-V6). Through mnemonic aids and clinical anecdotes, students gain a comprehensive understanding of lead placement techniques, enabling them to navigate the complexities of ECG recording with confidence and precision. As the lecture unfolds, Dr. Faiza delves into the nuances of ECG interpretation, empowering students to correlate ECG findings with electrophysiological events in the cardiac cycle. With a focus on waveform morphology and rhythm analysis, students learn to determine heart rate, rhythm, and axis deviation, deciphering the electrocardiographic manifestations of various cardiac pathologies and physiological states. Moreover, the lecture explores the normal waves, segments, and intervals of an ECG, providing students with a detailed roadmap for interpreting these essential components. From the P wave to the T wave, students gain insight into the voltage, duration, and clinical significance of each waveform, equipping them with the skills to identify aberrations and anomalies in ECG tracings. Enriched with clinical pearls and practical tips, this lecture serves as a cornerstone for students embarking on their journey into cardiovascular medicine. By demystifying the art of ECG interpretation, Dr. Faiza empowers students to harness the power of this diagnostic tool in clinical practice, fostering a deeper appreciation for the intricate interplay between electrical activity and cardiac function.

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MedicoseAcademics

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CHCAA some health care fraud cases

1. Some health care fraud cases

5. Fraud Cases cont'd  Dr. jailed for trafficking pain killers  Drug addicts a hit with Vancouver pharmacy  Fake nurse defrauds insurers  Wanted Canadian doc tracked to Newcastle, UK.

8. Some Case Studies  CBC TV Investigative report - dental  A woman from Brampton charged with 234 counts of double doctoring and fraud for prescription narcotics  A pharmacist charged with obtaining prescriptions for high priced drugs and paying the patient a percentage of the total prescription – not dispensing the meds however billing ON Gov. for the prescription.  A US citizen charged who was receiving insured medical services for which he was not entitled

9. Some Case Studies  Foot care practitioners charged with submitting fraudulent claims to OHIP  A Pharmacy case – fake Norvasc medication being dispensed to clients and the coroner investigating if this contributed to the deaths of multiple patients  A Canadian pair who were charged over their fake Cancer clinic – this affected over 800 patients in Mexico totaling 12 million dollars

10. Contact Us Canadian Health Care A Anti-fraud Association (CHCAA) www.chcaa.org Phone 416-593-2633 e-mail info@chcaa.org

CHCAA some health care fraud cases

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