Elements of the Case
Healthcare fraud is one of the most frequently committed crimes and is the most frequently pursued under the Federal False Claims Act (FCA). Parkman and her cohorts defrauded Medicare by distributing extra medical equipment. Power wheelchairs were among the supplies provided for Medicare recipients in New Orleans. The evidence established that Parkman received bribery payments from the defendant, Tracy Richardson Brown. In this instance, Brown was the seller; he was the owner of the medical supplier firm.
The company’s role was to collect signatures on equipment order forms and provide personal information for designated Medicare enrollees. Kickbacks of $47,000 were given to Parkman, causing Medicare to make a fraudulent $3.2 million payment (“New Orleans woman sentenced to prison for role in $3.2 million health”, 2018). The type of fraud broken is called kickback, which is described as a kind of healthcare fraud using a New Orleans case study about a woman charged with this crime.
This crime concerns Sandra Parkman, who was sentenced and fined $277,197 in reparations on November 8th, 2017 (“New Orleans woman sentenced to prison for role in $3.2 million health”, 2018). Parkman was found guilty of one count of conspiring to conduct fraud and receive kickbacks for medical services. Although kickbacks frequently take many forms, cooperation between two parties is their most prevalent element.
Penalty for the Perpetrator
This legislation mandates that the prosecution prove if a “kickback,” including commission, fees, cash, gifts, gratuities, remuneration, or anything else of value, was granted. Parkman breached the law by earning $47,000, causing Medicare to lose more than $3.2 million in this case (Pozgar, 2020). Identifying the motive behind the kickback is crucial for pursuing legal action.
Gaining preferential regard is a banned purpose under the legislation. The contract was illegally awarded to Tracy Brown’s company by receiving the kickback, which caused subsequent violations of the federal Anti-Kickback Act since some payment was made to expedite the transaction. The number of unauthorized referrals generated and the level of incentive harm determine the offenders’ punishments. Therefore, the penalty for the perpetrator was appropriate since Parkman paid $277,197 in restitution, and Brown received a sentence of up to 80 months in prison.
Minimization Control of Fraud Risk for a Healthcare Organization
The complexity of the healthcare system continues to rise due to increasingly careless and unethical medical procedures. Healthcare organizations need a corporate compliance policy to lessen the risk associated with such actions. Under the Corporate Compliance Program, accurate billing is assured, making it simple for the government to prepare an audit report and launch an inquiry in case of possible fraud. In addition, healthcare providers must ensure that all billing procedures are proper and that there are no instances of unreported services or overcharging.
The program also guarantees that documentation is maintained and updated correctly. Accurate records guarantee the most outstanding results for patients in subsequent treatments. The records can be used as evidence to support a defendant in court proceedings.
Transparency fosters trust between healthcare professionals, patients, and other institutions (Johnson & Smith, 2018). It is crucial to declare conflicts of interest to lower instances of fraud. Fraud cases not only result in legal claims but also competing interests. Before signing any agreement, healthcare professionals should consider the potential effects on their practice. All parties involved in the medical industry should educate staff members on how to spot fraudulent billing methods and stop them.
References
Johnson, C. S., & Smith, C. M. (2018). Preparing nurse leaders in nursing professional development. Journal for Nurses in Professional Development, 34(4), 226–227. Web.
New Orleans woman sentenced to prison for role in $3.2 million health care fraud and kickback scheme. The United States Department of Justice. (2018). Web.
Pozgar, G. D. (2020). Legal and ethical essentials of health care administration (3rd ed.). Jones & Bartlett Learning.