In "scheme greed," DeKaye goes on to provide examples of how individuals and even families exploit the thinly protected Medicare and Medicaid programs from theft of individual and provider identification numbers to facilitate generating false claims. He also describes how these schemes operate as they move from one geographic area to another to avoid being detected. Ethnicity and barriers to employment entry are also presented as contributing factors to this type of greed. The entry of organized crime into healthcare is portrayed as criminal enterprises seeking out lower penalties than drug-trafficking and other crimes to capitalize on schemes and other weak points in the trust based Medicare and Medicaid programs.
While painting these various portraits of the criminal mind, DeKaye does explore the enhanced role that health care boards of trustees are beginning to play in order to reduce an organization's vulnerability. He also indicates that the same type of data-mining used by federal and state agencies to target fraud could also be employed by providers to build their own internal data defense systems of protection. He also describes the types of screening that should be considered when hiring new employees.
DeKaye called upon colleagues from the legal, accounting and human resources arenas to offer additional perspectives on how healthcare providers can protect themselves from the internal and external assault of fraud, abuse and waste. He also provides insight from the prosecutorial perspective as law enforcement nationwide ratchets up the HEAT (new national task force) on fraud detection, investigation and prosecution.
The two-part article can be downloaded from DeKaye's home page at his w
|SOURCE DEKAYE Consulting, Inc.|
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