Nursing Homes, Essay Example

The DHHS-DOJ report is an annual event that is undertaken to reflect upon the gains that have been made in the fight against Health care fraud and abuse control in the US. This is a very important event in our calendar because it gives us time to sit back and reflect upon what we’ve achieved and what needs to be done. This event was started the way back in 1996 with the enactment of the health insurance portability and accountability Act. Since then it has made great steps towards achieving the objectives for which it was created (DHHS-DOJ, 2010). In the year 2010 the report came up with many actions by the government that needs to be addressed. The most striking actions were as follows:

• Fraud by nursing homes
• Houston (southern district of Texas)
• Los Angeles (central district of California)

Beginning with fraud by nursing homes, it was reported that in January 2010, five nursing homes operated by a Texas corporation pled guilty to felony by not providing adequate health care to residents in Medicaid and Medicare. They were owned by a Texas based corporation called Cathedral rock. It was alleged that Cathedral rock submitted false documents claiming for payment of services that were either not delivered or not up to the claimed standards. Secondly we’ve the case of Los Angeles where in June 2010 the district court sentenced co-owner of DME Company 57 month’s imprisonment. This was after he pleaded guilty to a charge of high level conspiracy to commit fraud. He was co-charged with another conspirator who also was sentenced to 30 month jail term. In this case they pleaded guilty to conspiring to defraud Medicare beneficiaries after purportedly supplying nutrition kits and some medical devices that were non existent. Finally there is this case where a patient recruiter was imprisoned for 21 months after being found guilty of recruiting non-existent patients to benefit from Medicare (DHHS-DOJ, 2010).

In all this cases it is vital to note that the root causes of the cases are conspiracy. In all auditing terms, conspiracies are very hard to control in any given situation. Thus no amount of regulation or legislations will stop such frauds from taking place. The only remedy is for the public to be enlightened on the need to be patriotic enough and leave aside their selfish interests and put national interests first. Thus we need citizens who are guided by ethics and patriotism rather than egocentric interests (Gardiner and Lyman, 1999).

References

DHHS-DOJ Health Care Fraud and Abuse Control Program Report available at: http://oig.hhs.gov/publications/docs/hcfac/hcfacreport2010.pdf

Gardiner, J. A., and T. R. Lyman, The Fraud Control Game: State Responses to Fraud and Abuse in AFDC Medicaid Programs, Bloomington, Indiana: Indiana University Press1999.