Current Events

Perform an Internet search and find a current events topic over the last 3 years that is related to this chapter 11 Healthcare Law - Basics of the U.S. Health Care System (4th Edition). Provide a summary of the article and the link to the article and explain how the article relates to the chapter.

 

Summary:

According to the article, the largest health care fraud and opioid takedown in the United States, involving 345 defendants responsible for more than $6 billion in alleged fraud losses has been made. This was spearheaded by multi-team committee which collectively announced a historic nationwide enforcement action involving 345 charged defendants across 51 federal districts, including more than 100 doctors, nurses and other licensed medical professionals.

Based on the article, the defendants were charged with submitting more than $6 billion in false and fraudulent claims to federal health care programs and private insurers - including more than $4.5 billion connected to telehealth and more than $845 million connected to substance abuse treatment facilities.

The arrested individuals are alleged to have participated in schemes involving the payment of illegal kickbacks and bribes for the referral of patients to substance abuse treatment facilities who were then subjected to medically unnecessary drug testing and therapy sessions that were frequently not provided, which resulted in millions of dollars of false and fraudulent claims being submitted to private insurers. Medical professionals also allegedly prescribed medically unnecessary medications, including controlled substances, to these patients, sometimes in an effort to entice them to stay at the facility. Unbelievably, patients were often discharged only to be admitted to other treatment facilities, or referred to other laboratories and clinics, in exchange for more kickbacks.

The center of this fraudulent activity is the illegal opioid prescription. According to the government, in many cases, patient recruiters, beneficiaries and other co-conspirators were allegedly paid cash kickbacks in return for supplying beneficiary information to providers, so that the providers could then submit fraudulent bills to Medicare. These cases also involve charges against medical professionals involved in the distribution of more than 30 million doses of opioids and other prescription narcotics.

Lastly, this article highlights the move of the DOJ to create the National Rapid Response Strike Force of the Health Care Fraud Unit of the Criminal Division's Fraud Section. This new Strike Force's mission is to investigate and prosecute fraud cases involving major healthcare providers that operate in multiple jurisdictions.

How this article relates to Chapter 11- Healthcare Law

ANS: I believe this article is related to this chapter as the article talks about healthcare fraud. In the Chapter, it is emphasized that the healthcare industry is one of the most heavily regulated industries. It is governed by different forms of laws, such as the public, private, common, criminal, and civil laws, which all maintain the the order and justice in this industry. It is also highletded in the chapter that Healthcare Fraud is the most common violation in the helathcare industry. Hence, the relevance of this article. This article further elaborates and exposes how massive and corrupt our healthcare system can be. It indeed has a lot of loopholes in it and the agencies that govern this industry should be able to enforce the law to create a safer and a more transparent healthcare for everyone, devoid of fraud and illegal activities.