Week 7
Erica Clayton
Spring 2015
Belhaven University

Week 7 Hospital-based doctors include specialists such as a pathologist, radiologist, and anesthesiologists. Each one of these specialties is reliant on their position at the hospitals where they receive referrals from other specialist and physicians. Also, hospitals regularly perform various services for these specialties. Consecutively, hospitals depend on the hospitals based doctors because they provide essential services to the hospitals. Some hospitals have the cut-rate payment for hospital-based physicians, and some are requiring payment from doctors to reimburse hospital of the payments that performed for the services rendered. Medicare regularly pays for the services of the hospital based doctors in various ways. In some instances, Medicare pays physicians directly for the services provided. For an example, when a pathologist performs laboratory services for the hospital inpatients which has Medicare part A, some part of the Medicare's prospective payment amount to the hospital is for pathology service that provided. Technical and professional components are paid separately from the hospital-based physicians. There are federal statutes that involved criminal prosecutions under the fraud and abuse laws. There was a doctor named Greber. He ran a laboratory service that provided Holter monitors that were ordered by cardiologists. Greber's business matched the monitors to the patients that collected information and prepared the information for reading by the ordering cardiologist. The cardiologists who were ordering the tests was paid a consulting fee for examining the patient's monitor data. There were charges filed for fraud. In the defendant criminal prosecution, it was speculated that a fee that obtained was illegal incentive to persuade the doctors to use Greber's services. Greber defense was that there were not illegal incentives for the referral of patients, but the fees for the referral services were legitimate. The court finds that if the payments were proposed to persuade the doctors to use Cardio services, the law was violated even if the payments were intended to pay for professional services. The case was a prime example of Medicare fraud and abuse. There is a significant difference between misdemeanor and felony. When crimes are committed, they are classified into two categories. If a crime is less serious, they are considered as misdemeanors. Misdemeanor crimes, for example, are speeding tickets. Tickets are classified as a misdemeanor. Misdemeanors are not more serious than felonies. Misdemeanors are usually punishable for up to one year in jail. On the other hand, felonies are more serious. For an example, when a person commits murder or rape, those are classified as felonious crimes. Misdemeanor crimes are usually punishable for at least a year of jail time. Felony crimes are punishable by several years of jail time. The effect of changing Medicare fraud offenses from misdemeanors to felonies caused a more level of accountability to health care providers. Healthcare providers must comply with the law on both the state and federal levels, such as the False Claims Act, The Anti-Kickback Statute, The Physician Self-Referral Act (Stark), The Exclusion Statute and The Civil Monetary Penalty Law. These five laws involve the Medicare fraud and abuse laws. The federal government made the fight against health care fraud a main priority. The federal government and law enforcement have buckled down more on fraud against Medicare agencies. There are so many healthcare providers that have committed fraud. In enlighten of the penalty of fraud and abuse laws, it is understandable as to why the Medicare fraud was moved from a misdemeanor to a felony crime. The reason to support this statement is that the government has made health care providers become more accountable for the Medicare and government laws. This fraud when it takes place does not only affect the healthcare providers, but it also affects the innocent patients that are involved in these white collar crimes. Accountability is a word that healthcare providers must have in their daily activities and their daily actions.