Fraud and Abuse Enforcement

Fraud and Abuse Enforcement
Student’s Name
Institutional Affiliation
Course
Instructor
Date
Fraud and Abuse Enforcement
According to the US Department of Health and Human Services: Office of Inspector General (OIG), healthcare practitioners should desist from fraudulent activities such as the submission of false claims. OIG investigates or relies on law enforcement partners to unmask instances of violations and fraud, which invites legal actions such as administrative, civil, and criminal actions. An example of such cases is the 28th November 2022, US Attorney’s Office, Middle District of Pennsylvania release “Medical Doctor to pay $86, 506.30 to resolve civil liability for alleged violations of the false claims act.” In this case, investigations established that Dr. Musaddiq Nazeeri allegedly violated False Claims Act, which resulted in civil liability. Resolving the civil liability required $86, 506.30. The investigation revealed that the doctor committed fraud, which primarily entailed billing the medical insurance for extra services that are not outlined in the medical record. Gerard M. Karam, US Attorney, reported that the doctor did not provide evaluation and management services. However, in the Medicare billing, he indicated that the above service was offered alongside a COVID-19 vaccine. This violates the False Claims Act because the services were not rendered, and the intentions were evidently to defraud Medicare. The US Attorney indicated that such kinds of fraud and abuse adversely affect programs funded by taxpayers, hence the exploitation of every means to combat and resolve them. Office of the Inspector General, US Department of Health and Human Services Special Agent Maureen R. Dixon reiterated the US Attorney’s claims indicating that False Claims Act is fraud and investigations in such cases are often prioritized.
Importantly, The US Department of Health and Human Services Office of Inspector General investigated the above instance of fraud. Studies suggest that False Claims Act violations are one of the leading examples of fraud in healthcare (Adashi & Cohen, 2022). The objective often includes defrauding federal government healthcare insurance, which includes obtaining money for services not rendered, as was in the above case. The doctor billed for services that they did not provide, which implies that Medicare payment included false statements that would facilitate access to extra payments. Defrauding Medicare is a violation of US laws and invites legal actions such as penalties and imprisonment.
Evidently, the law broken in this case is the False Claims Act, which states that “false claims for goods and services not actually provided, the substitution of inferior goods or even presentation of fraudulently obtained government checks for payment can be prosecuted in qui tam suits (Sherman, 1977, p. 493).&rd...