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Articles Or Case Law Search: Health Insurance Case

Decent Essays

Articles or Case Law Search
Tiffany Carmouche, Kiara Ingram, Heidi Jansen, & Heather Mack
HCS/430
May 15, 2017
Kristen Hauck

Introduction In the health care system there are many laws and regulations that are put into place to protect the patients that use the health care system as well as the facilities and insurance companies. Unfortunately in some cases physicians, facilities and employees break these laws and cause a critical problem in the system. In the case of Park Ridge Hospital and Adventist Health Systems, Park Ridge Hospital was found guilty of insurance fraud and over charging patients. These fraudulent charges and procedures not only cost the patients money but also have a huge impact on health care all together. …show more content…

One example of many health insurance fraud cases involves a $115 million whistleblower settlement involving Park Ridge Hospital and Adventist Health System. The lawsuit arose when three longtime employees of Park Ridge hospital had creditable insider knowledge about the hospital paying kickbacks to physicians’ who were intentionally referring their patients to the hospital for illegal monetary incentives. The civil suit also alleged that the health system was overbilling patients for medical services. One example of the overbilling is when Park Ridge Hospital devised a scheme with partnering physicians to perform outpatient procedures inside the hospital for higher reimbursement when in fact the procedure could have be done in an office setting at a lower cost. The act of health care fraud not only financially hurts the victims but it also compromises the quality of the patients care and puts patients’ health at risk. Adventist Health System agreed to settle the lawsuit with the United States government for $115 million dollars which includes the whistleblower’s reward, which will roughly amount to a little over $118 million after legal fees are calculated (Moss, …show more content…

They settled on a $115 million settlement on these charges. Violating these laws has a domino effect on the health care system as a whole. From over charging patients more money than they needed to pay to filling insurance charges that were unnecessary. These laws that were broken not only changed the way they conducted their business, but was an eye opener for the community overall on how insurance fraud can effect them personally or in the long run country

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