Patient Recruiters and the Anatomy of Healthcare Scam from Nurse Together

Healthcare scams are constantly evolving and costing tax payers billions of dollars, most of which will probably never be recovered. The U.S. Department of Health and Human Services’ strike force operations have obtained over 1,000 indictments for individuals who have fraudulently billed Medicare for more than $2.3 billion since March 2007.

A healthcare scam is the premeditated fraud carried out by a provider, hospital, clinic, employer group, member, or other group or individual for illegal financial gain. Fraud takes many forms, and can involve what are known as “cappers,” or patient recruiters who literally recruit patients to become part of a healthcare scam designed to bilk millions out of the Medicare program.

For the full article please go here.

Riding Herd on the Silver Stampede from H and HN

Are you ready for the "Silver Stampede?" That's the question contributing editor Geri Aston asked hospital leaders in her December Hospitals & Health Networks article on the onslaught of older patients, which will have — indeed, already is having — an enormous impact on our health care system. Like most of the stories we run in H&HN, the focus of Geri's article was on real-world solutions — positive, practical ways health care organizations are confronting a difficult issue, in this case senior care, so that other hospital leaders can decide whether those strategies might be worth adapting in their own organizations.

I write frequently in this space about generational issues in health care, and after Geri's article ran, I heard from a number of readers wanting to let me know that they and their colleagues also are taking creative steps to confront this issue. Here are four you might find interesting and useful:

For the full article please go here.

A New Threat: Patient Predatory Lending Claims from Medical Malpractice Blog

Michael J. Sacopulos, Esq.

An doctor was sued several weeks ago for her use of a healthcare financing company. The suit was brought as a class action and is based upon consumer fraud laws. The allegations center around the way the credit application was presented and when it was signed by the patient. The patient claims that she did not understand that she was signing a credit application and that the practice performed unnecessary work in an effort to collect the entire amount of her line of credit. The doctor needs to prepare for a long, painful process. This is not a medical malpractice case, so normal professional liability policies will not cover it. Further, given the general public’s current hostility towards finance firms, there is a risk to taking the case to a jury.

Basically, this is a predatory lending case. Predatory lending is a general description for activities that violate consumer laws. A common element to most predatory lending cases include the lender or lender’s agent engaging in fraud or deception to conceal the true nature of the loan obligation from an unsuspecting or unsophisticated borrower. This means that a practice could be sued based on what information was presented to a patient or for how a signature of the application was secured.

For the full article please go here.