In five pages this paper examines attempts at preventing Medicare abuses in a consideration of regulatory agency efforts and Medicare PPS. Six sources are cited in the bibliography.
Name of Research Paper File: CC6_KSmediRegulat.rtf
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in Columbus, Ohio conducted a "Senior Treatment Enrichment Program" to provide psychiatric services to older adults. The patients were mostly residents of local nursing homes and were transported to
the hospital to take part in the program. On its surface, Park Medicals program appeared to be a beneficial one, but the center consistently billed Medicare and Medicaid for
20 therapy sessions each week for each participant, averaging nearly three sessions per patient daily if sessions were held seven days a week. Closer inspection revealed that the activities
undertaken during these group therapy sessions were not psychiatric in their focus, but rather more for entertainment purposes. Psychiatric services are covered by
Medicare and Medicaid; adult daycare is not (Montooth, 1996). The U.S. Attorneys office for the Southern District of Ohio conducted a two-year investigation of Park Medicals billing practices; the
final outcome was that Park Medical agreed to pay $1.45 million to settle the investigation and escape criminal charges of massive Medicare and Medicaid fraud.
This is one of the largest settlements reached in the many similar cases that have come under review. Aside from the fraud involved, the great pity is
that Park Medical had hired a contractor, Quorum, to conduct the program. Shortly after agreeing to pay the large settlement, Park Medical immediately filed suit against Quorum in an
effort to recover the funds. It appears that Quorum intended to defraud, but it was Park Medicals lack of any type of coordinated guidelines effort that allowed the abuse
to go unnoticed for so long. Scrutiny of Payments For decades, jokes about the governments $200 hammers and $600 toilet seats were passed