The Agent For Optum Health Behavioral Program

The Brooklyn District Attorney’s office, DA Ken Thompson, charged Eric Vainer and his mother Polina Wainer who own a Durable Medical Equipment clinic is also the mastermind along with twenty-three other defendants including nine doctors from different medical clinic across the borough of the Bronx, Brooklyn and Queen with $7 million dollars in Medicaid and Medicare Fraud between October 1, 2012, and September 30, 2014. Moreover,

The counselor met with the patient for her scheduled Addiction Severity Index assessment. The patient is a 54 year old black male. The patient states he is single with no children. He report currently lives with sister in law of his decease brother. The patient reports having a 14 years of education however no degree. The patient report receiving disability for mental health disorder. The patient reports he is currently not on probation. The patient reports he last use Cannabis 7/17/15 and started using at the age of 13 and smokes 3 to 4 times a week at least 2 joints. He also report using Alcohol 7/20/15 a 40oz beer and usually drank a couple a day. The patient denies any issues with HI/SI. Patient also reports he is taking his medication as prescribed. The patient appear to be in the pre-contemplation stage of change. The patient next scheduled individual session with the counselor is on Monday, July 27, 2015 at 02:30p

Xavier then reported, the applicant recovery is up and down and the reason the patient was transferred and admitted to the Norwich location was due to an altercation as the Hartford Dispensary has zero tolerance for physical violence. Since May of of this year, the applicant's UDS results are negative. Last positive result was in April for cocaine, according to the counselor. Please note, during the applicant intake, he was asked about other illicit drugs and only confirmed for use of heroin and THC, not the cocaine. The applicant's current dose at the Hartford Dispensary is 105mgs as he is being detoxed daily. His highest dose was at 145 mgs before his detoxification. The physical altercation was the applicant's first behavioral incident at the clinic. He was also on a 90 Probation for his illicit use and it would have expired in August, but due to the recent incident, he was removed from the clinic, not discharged, but transferred as mentioned before. Counselor Xavier only concern of the applicant is maintaining his

In the news recent was the Miami physician pleads guilty for role in $20 Million health care fraud scheme (Justice. Gov). The FBI and HHS-OIG investigated the case, which was brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office of the Southern District of Florida (Justice.

Insite provides the community members with a safe place to inject their drug. They provide people with injection equipment’s such as syringes, cookers, filters, water, etc (Insite Supervised Injection, Services section, 2011, para. 3). At the site, there are many trained nurses to help facilitate the process of injection into the patient. “More than 400 overdoses have occurred at the facility, but nobody has ever died there from one” (Geddes, 2010, para. 7). With that being said, over 1,200 people died between 1990 and 200 because of

The following allegation is upon Southwest health alliance who runs under BSA provider network in the region of Amarillo, Tyler, TX who is believed to be respondent under section 5 of Federal Trade Commission Act where the Respondent has exhibited Anticompetitive Conduct in the market and which incurred the reduction of consumer benefits in the healthcare market. Upon being proved guilty of allegations, Federal Trade Commission along with the help of Office of Texas Attorney General purposed few judgements in the form of consent order which involves settlements purposes.

A system in Optum’s organizational culture is the complex, detailed work in a fast-paced claims review department metrics, processing a minimum of eighty claims per day. Although Optum has a quality assurance review of whether the case management department addresses the value drivers: right care, right providers, right medications, right lifestyle, and depression screening, a quality assurance review of claims processing including the measurement of member’s satisfaction with their claims processing has not been instituted. To improve member safety and quality of care, communication, collaboration, and commitment must be the cornerstone for a positive organizational outcomes (Melnyk, Gallagher-Ford, Long, & Fineout-Overholt, 2014).

Tiffani is a 26yo, G2 P1001, who was seen for a viability ultrasound assessment and consultation. The patient is actively using large amounts of heroin on the street along with Xanax, alcohol, and marijuana. She strongly desires inpatient treatment. Her LMP she believes was sometime in April around the 15th but she is unsure. This would give her an EDD by dates of 01/20/18 placing her at 7 ½ weeks. She has a very longstanding history of abuse involving mental, physical, and sexual in her past history and has issues with anxiety but is currently not on treatment other than she states she uses the Xanax off the street for this purpose. Currently at this time she denies any pelvic pain or vaginal bleeding.

SC, Jennifer Stoker contacted the provider, Pam Provider via telephone. SC introduced herself and told provider that she was Bo’s. Pam noted she got MIW for Bo. Parkland police has pick him up. SC noted to Pam she have to allow Bo to come into the home. SC noted she talk with Consumer rights and services (CRS). SC informed Pam that CRS noted she has to continue to be BO provider until he chose to move. It is not her decision to try to get Bo to leave. Pam noted SC need to from BO somewhere to stay once he is released from the hospital. Pam noted SC need to find him a placement. SC noted to Pam that Is her reasonability as Bo

Mr. Overman is a 30 year old male who presented to the ED with a possible overdose. Per documentation he was found in a Walmart walking around taking multiple pills while walking around. Mr. Overman has a prior history of substance abuse which includes abusing pain pills. Mr. Overman wife was contacted and spoke to before the assessment. She reports in October 2016, Mr. Overman was in a hit and run accident while riding his bike with their son. Mrs. Overman reports yesterday he found out he would not be able to continue the type of work he has been doing for the past 6-8 year. Mrs. Overman reports he has been depressed due to becoming aware of this information. Also, She reports since he had been prescribed a large amount of pain medication from his providers, a solution for one provider to aid in medication management was organized because with the 30 day prescriptions were out his detox from the medication was overwhelming to him.

There are also special laws in place that help fight against healthcare fraud and abuse. The False Claims Act protects the government from being overcharged or sold less than standard goods or services. The FCA imposes civil liability on a person or entity that submits a fraudulent claim to the federal government. Civil penalties may include fines for up to 3 times the amount of cost in damages to the government for submitting the fraudulent claims (CMS, 2012). The Physician Self-Referral Law or Stark Law prohibits a physician from making a referral for certain health services to an entity in which the physician has a compensation agreement. Civil penalties include fines as well as exclusion from all Federal healthcare programs (CMS, 2012). The Health Care Fraud and Abuse Control Program (HCFAC) was established under the Health Insurance Portability and Accountability Act of 1996. “During the time period from 1997 to 2007, HCFAC collected over $11.2 billion in fraudulent claims, $1.8 billion in 2007 alone” (Rudman, 2009, para.9).

The plaintiff brought actions under the FCA, the AKS, as well as the ICPFA and the Florida False Claims Act. In this case, the Esformes brothers had formed a group of companies called Total Pharmacy. At the time Total Pharmacy was formed, Morris Esformes had an ownership in 27 nursing homes in Illinois and Florida. Philip Esformes had an ownership in 13 of those homes. The basis of the relator’s contention was that the defendants formed Total Pharmacy with the intention of securing business from the Esformes Homes, and gave Philip his equity interest in Total Pharmacy in order to induce referrals of that business. The case against Omnicare settled in July 2013 for $98 million in Massachusetts, and the case was transferred to Illinois regarding the remaining defendants.

In the case study, there has been fraudulent activity in this office that would warrant criminal sanctions. There have been claims filed in which patients were seen by an NP but billed as though they had seen a physician, at times, even when that physician was not in the office that day. This is a

The patient arrived on time for her counseling session. Reports stability on her dose and denies the need for a dose increase when it was offered by the writer. When questioned about what caused her to relapse recently, the patient started to cry as she did in fact regret her recent relapse as she said, " I didn't need that shit.....it didn't do anything for me......I am just tired Charlene, now there is warrant for my arrest and I may be charged with a felony for larceny. I just stressed out because I need to come up with $500 to pay this lawyer to drop the charges to a misdemeanor. The entire cost for the lawyer to represent me is $2500 that I honestly don't have, Charlene." The patient was tearful throughout the session. The writer validated

Assessment: The patient continues to comply with the clinic's intervention, but continues to test positive for illicit drugs. According to the patient, she bases on her relapses on stupidity. This writer strongly advise the patient to take her recovery serious due to the length of time in treatment and the ongoing positive result as no changes have been made. Please note, the patient appeared to be alert and oriented. No evidence of