Fraud in Healthcare

In: Business and Management

Submitted By gvheremu
Words 1936
Pages 8
Gloria Vheremu
ACC 444 Honors Contract Fraud in the healthcare system
EXECUTIVE SUMMARY
The purpose of this research is to learn about fraud cases that have been happening in the healthcare system for the past few years, and how those fraudulent acts were pioneered and executed. The main focus will be on three of the many pillars that make fraud a reality fraud – committing, concealing and detecting; that is; how the fraudulent was committed, how the perpetrator concealed it and how it was detected by the relevant authorities. Focusing on these three areas gives us the opportunity to take an in-depth look into the loopholes that are making it easy for perpetrators of fraud to be able to commit and conceal fraud and how their actions were detected. The paper will focus on only three of the many cases that made the topic of fraud in the healthcare a force to reckon from 2013 to 2015. These cases include a psychiatrist from Chicago, Lloyd Torrez who was found guilty of defrauding insurance companies; Empowerment Non-Emergency Medical Transportation, Inc. an enrolled Medicaid provider being led by its owner, Ms. Shorter, which was defrauding the Indiana Medicaid; and Paula Cluding, owner of Prairie View Hospice in Oklahoma who provided millions of dollars’ worth of fraudulent claims to the federal Medical Care program.
INTRODUCTION
Fraud is deliberate deception to gain unfair and unlawful gain from an act. It is both civil and criminally wrong, and the people who commit fraud usually do it to gain monetary gain or material benefits, but the ones who commit fraud to gain monetary gains are the most common. The elements of fraud as a crime similarly vary. The requisite elements of perhaps most general form of criminal fraud, theft by false pretense, are the intentional deception of a victim by false representation or pretense with the intent of persuading…...

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