Fraud is the result of government and insurance company control of health care. The growth of bureaucracy is a precursor to incompetence and soaring costs of medical care. A lack of clinical diagnosis and a dependence on expensive testing has increased costs while decreasing the doctor's competence. The FBI and the attorneys general of all states are dealing with exploding health care fraud. The result is a trillion dollars in waste and deception. Trillion Dollar Scam details the origin of this fraud and waste, and offers solutions to fixing the broken U.S. health care system.

Understanding the powers, procedures and remedies available to the government during a health care fraud and abuse investigation, and acquiring a basic understanding of the issues and practical steps to employ during an audit or investigation, are keys to surviving the investigation and achieving a favorable outcome.This new Handbook will arm health care administrators, executives, medical directors, office managers, physicians, and medical practice managers with a broad understanding of this industry-specific area of government enforcement. The resource is complete with:Clear and concise explanations of the lawSample government documents, affidavits, and subpoenas accompanying each chapterIllustrative pleadings and memoranda prepared by prosecutors and defense attorneysThe authors detail the nuts and bolts of a fraud and abuse investigation, from an overview of the various federal and state enforcement agencies to the potential of settling a case. Learn what to expect and how to respond with coverage of:Requests to examine books and records dealing with an organization's programs and operationsInterviews of employees by the OIG or the FBIThe power of HIPAA administrative subpoenas and the broad authority granted under this statuteSteps that should be taken in responding to the government's requestDealing with on-site demands for records and accessInternal audits and investigationsVoluntary disclosuresAffirmative actions to try and fend off an investigation, plea agreements, and deferred prosecution

Over the past couple of decades, individuals have come to rely more on home health care visits for their health care needs. While there have been decreases in hospital stays and in the percentage of older persons living in nursing homes the consequence has been the emergence of a new type of occupational crime: home health care abuse. In considering offending in the home health care industry, it is important to focus on crimes by and against home health care professionals. This book is one of the first to fully address abuses occurring in the home health care industry. Its intent is not to suggest that home health care is a dangerous field for workers and consumers; rather, the intent is to shed some light on the types of misconduct found in home health care. Each chapter will include a wealth of examples to illustrate that these incidents actually are real, devastating, and significant. At the end of each chapter the reader will find a series of discussion questions designed to encourage the reader to reflect back on the content of the chapter through the eyes of those involved in the response to home health care fraud. Also included are Web site addresses where readers can learn more about the offenses and other resources to help demonstrate ways to deal with the problem. It is intended for criminal justice officials, health care professionals, academics, and researchers who want to better understand the nature of offending in the home health care industry. It is also intended for use in criminal justice, sociology, and white-collar crime courses exploring crime in the workplace as well as courses examining the home health care field. Chapters include: Home, Home on the Range: Where Health Care is Provided and Crimes are Committed; Home Health Care Professionals as Victims and Witnesses; Crimes by Home Health Professionals: Violence, Theft, and Deception; Responding to Crime in the Home Health Care Field: Strategies, Obstacles, and Issues; and Preventing Home Health Care Misconduct.