Stepped-up efforts to ferret out health care fraud have put every provider on the alert. The HHS, DOJ, state Medicaid Fraud Control Units, even the FBI is on the case -- and providers are in the hot seat! in this timely volume, you'll learn about the types of provider activities that fall under federal fraud and abuse prohibitions as defined in the Medicaid statute and Stark legislation. And you'll discover what goes into an effective corporate compliance program. With a growing number of restrictions, it's critical to know how you can and cannot conduct business and structure your relationships -- and what the consequences will be if you don't comply.

Who steals? An extraordinary range of folk -- from low-life hoods who sign on as Medicare or Medicaid providers equipped with nothing more than beepers and mailboxes, to drug trafficking organizations, organized crime syndicates, and even major hospital chains. In License to Steal, Malcolm K. Sparrow shows how the industry's defenses, which focus mostly on finding and correcting billing errors, are no match for such well orchestrated attacks. The maxim for thieves simply becomes "bill your lies correctly." Provided they do that, fraud perpetrators with any degree of sophistication can steal millions of dollars with impunity, testing payment systems carefully, and then spreading fraudulent billings widely enough across patient and provider accounts to escape detection. The kinds of highly automated, quality controlled claims processing systems that pervade the industry present fraud perpetrators with their favorite kind of target: rich, fast paying, transparent, utterly predictable check printing systems, with little threat of human intervention, and with the U.S. Treasury on the end of the electronic line. Sparrow picks apart the industry's response to the government's efforts to control this problem. The provider associations (well heeled and politically influential) have vociferously opposed almost every recent enforcement initiative, creating the unfortunate public impression that the entire health care industry is against effective fraud control. A significant segment of the industry, it seems, regards fraud and abuse not as a problem, but as a lucrative enterprise worth defending. Meanwhile, it remains a perfectly commonplace experience for patients or their relatives to examine a medical bill and discover that half of it never happened, or that; likewise, if patients then complain, they discover that no one seems to care, or that no one has the resources to do anything about it. Sparrow's research suggests that the growth of capitated managed care systems does not solve the problem, as many in the industry had assumed, but merely changes its form. The managed care environment produces scams involving underutilization, and the withholding of medical care schemes that are harder to uncover and investigate, and much more dangerous to human health. Having worked extensively with federal and state officials since the appearance of his first book on this subject, Sparrow is in a unique position to evaluate recent law enforcement initiatives. He admits the "war on fraud" is at least now engaged, but it is far from won.

The Standards of Conduct Office of the Department of Defense General Counsel's Office has assembled an "encyclopedia" of cases of ethical failure for use as a training tool. These are real examples of Federal employees who have intentionally or unwittingly violated standards of conduct. Some cases are humorous, some sad, and all are real. Some will anger you as a Federal employee and some will anger you as an American taxpayer. Note the multiple jail and probation sentences, fines, employment terminations and other sanctions that were taken as a result of these ethical failures. Violations of many ethical standards involve criminal statutes. This updated (end of 2009) edition is organized by type of violations, including conflicts of interest, misuse of Government equipment, violations of post-employment restrictions, and travel.

Government contracting is plagued by nefarious, amateurish, and criminal behavior. By awarding government contracts to corporations as compensation for lavish gifts and personal favors, the United States government fails to serve the public interest effectively and honestly. William Sims Curry identifies and categorizes multiple deficiencies in how government contractors are selected, and proposes how reforms can be instituted.This book is based on extensive research. Curry sifted through two years worth of contractor claims maintained by the Government Accountability Office (GAO) regarding improper behavior of federal government agencies during the contract award process. He identified additional government contracting failures through review of media stories, inspector general reports, court cases, and press releases by government investigatory agencies.Much of this abuse originates from the mandated but ineffective practice of color coding rating proposals and a subjective ratings system. Curry proposes replacing the current practice with a scoring system that weighs contractor selection criteria according to the government's needs. This, along with the other procurement reforms Curry recommends, offers promise for an alternative to the fraud, waste, and incompetence currently rampant in government contracting.