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Your assignment is to prepare and submit a paper on healthcare qui tam. Healthcare Qui Tam

In Virginia, many hospitals were billing for outpatient procedures with codes kept for physician’s office visits rather than an outpatient procedure performed at the health center. Medicare pays a high rate for physician’s office appointments to mirror the cost of their operating cost (Warren &amp. Benson Group, 2009). Hospitals obtain a separate facilities fee to settle the overhead cost. Therefore, the correct repayment rates for hospital outpatient services are lesser. The hospitals agreed to a payment of $3 million.

A Pennsylvania hospital settled on paying a $2.7 million defrayal due to its upcoding fraud. The center was submitting claims for a multifaceted form of pneumonia when the accurate diagnosis showed a simpler form, which is compensated at a lower rate. The hospital decided to pay $500,000 for other upcodings with counterfeit claims for septicemia (Warren &amp. Benson Group, 2009).

A Florida hospital decided to pay $2,531,000 for issuing false claims for laser procedures executed as part of post cataract elimination surgery by demonstrating that the procedures were executed after the 39-day post-operative phase. It is also issued claims for actions, which were either never upcoded or rendered. Finally, they issued claims for two management services and evaluations per patient visit.

Finally, a Hawaii doctor agreed to recompense a $2.1 million settlement for issuing false claims to Medicaid. The doctor operated a pharmacy in his hospital. The doctor billed Medicaid for providing expensive drugs when the clinic issued cheaper generic substitutes (Warren &amp. Benson Group, 2009).

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