Springhill Care Group

WASHINGTON - The Obama administration is upping the ante in the fight against health care fraud, joining forces with private insurers and state investigators on a scale not previously seen in an attempt to stanch tens of billions of dollars in losses. Health and Human Services Secretary Kathleen Sebelius said in a statement Thursday that the new public-private partnership "puts criminals on notice that we will find them and stop them," while Attorney General Eric Holder called it "a critical step forward" against fraud, an endemic problem plaguing programs like Medicare and Medicare as well as private insurance companies. Details of the collaboration remain to be worked out, but the possibilities include sharing information on new fraud schemes as they pop up, using claims data to catch scams such as payments billed to different insurers on the same day for care purportedly delivered to the same patient in different cities, and using computer analysis to spot emerging patterns of fraud. The agreement is also unusual because it brings the Obama administration and longtime foes in the insurance industry together to tackle a common problem. While carrying out the requirements of President Barack Obama's health care overhaul law, insurers are also lobbying to roll back some of its provisions, such as new taxes on the industry and cuts to private plans offered through Medicare. Obama continues to rail against industry "abuses." Fraud is estimated to cost Medicare about $60 billion a year, and the Obama administration has beefed up the government's efforts to stop it, bringing in record settlements with drug companies for marketing violations as well as using new powers in the health care law to pursue low-level fraudsters with greater zeal. Yet, although Medicare is becoming a harder target, it's too early to say if the tide has turned. Some antifraud efforts launched with great fanfare have yet to

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ST. LOUIS * A Crestwood chiropractic center, the chiropractor and an employee have been indicted for billing insurance companies for work that was never done, federal prosecutors said Wednesday. Dr. Anthony Calandro, 55, of Chesterfield, and his billing assistant, Sherry Rueter, 62, of St. Louis County, billed insurance companies for X- rays that were never taken and appointments that had been canceled or missed, prosecutors said. The charges are the result of two undercover investigations in 2010 and 2011, they said. Calandro, Rueter and the Chiropractic Accident Centre each face one felony count of health care fraud and four felony counts of making false statements related to health care services. "Dr. Calandro has been working diligently with the federal authorities to address reconciliation of the billing issues and will continue to do so despite the indictment," said Albert Watkins, Calandro's attorney.

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Following the Money in Health Care Fraud: Reflections on a Modern- Day Yellow Brick Road-livejournal-zimbio

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http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1649474Health care fraud is all about the money. The United States spent an estimated $2.5 trillion on health care in 2009, with over $918 billion of that coming from the federal government. Under some estimates, up to 10 percent of that amount - no one quite knows for sure - might be lost to fraud.

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SEOUL (AFP) - South Korean police said on Tuesday they were investigating 27 North Korean refugees for swindling private insurance firms out of hundreds of thousands of dollars in bogus medical claims. Police said the refugees faked illness in collusion with hospitals to claim a total of 1.04 billion won (S$1.16 million) from insurance firms between 2007 and 2010. While listed as hospitalised, they frequented saunas, restaurants and even nightclubs. The scam also involved a 71-year-old doctor and five hospital employees who conspired with the refugees to claim a separate 104 million won from the state health insurance agency, police said. Police are also investigating two brokers on suspicion of helping the refugees send some of the proceeds to relatives in the North.

Following the Money in Health Care Fraud: Reflections on a Modern-Day Yellow Brick Road http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1649474 Health care fraud is all about the money. The United States spent an estimated $2.5 trillion on health care in 2009, with over $918 billion of that coming from the federal government.

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Springhill Group look to cater to the special requirements of each person citizen and any changing circumstances that occur throughout their time living in our care. This gives families the comfort that their loved one has the support and care. We fully understand a need to a place that residents will be proud to call their home is what they require most. All are built in attractive locations, nestled amongst existing communities, so our residents can easily retain their ties with their families. Springhill Care offers retirees the finest in clinical care, while receiving the positive aspects of living in our cozy and comfortable community. Email us now at info@springhillcaregroup.net

It was President Franklin Delano Roosevelt who once said 'With great power comes great responsibility.' Unfortunately, there are many people in our society that neglect their responsibility and abuse their power. Those who commit fraud against people who are disabled are especially heinous.

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Increased collaboration has yielded significant results through the HEAT partnership. Since the creation of HEAT in 2009, the Medicare Fraud Strike Force operations have expanded from two to nine locations throughout the United States, including Chicago. Strike Force operations expanded to Chicago in February 2011 and since that time, charges have been filed against more than 35 defendants in the Northern District of Illinois for offenses related to health care fraud. Overall, in fiscal year 2011, strike force operations in nine locations charged a total of more than 320 defendants for allegedly billing more than $1 billion in false claims. In February, as a result of HEAT and strike force actions, a Dallas-area physician and the office manager of his medical practice, along with five owners of home health agencies, were arrested on charges related to their alleged participation in a nearly $375 million health care scheme involving fraudulent claims for home health services. In conjunction with this action, CMS imposed payment suspensions against 78 home health agencies in the Dallas area.

TRENTON, New Jersey (AP) ― British drugmaker GlaxoSmithKline will pay $3 billion in fines ― the largest health care fraud settlement in U.S. history ― for criminal and civil violations involving 10 drugs that are taken by millions of people.

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Working and Business > Salary Deductions/Benefits Mandatory Pension Contributions:Since 1999, all foreign workers between the ages of 18 and 60, regardless of the size of the workplace or the number of employees, have been included in the mandatory Korean National Pension Scheme with only a few exceptions.

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Abstract: Health care fraud is all about the money. The United States spent an estimated $2.5 trillion on health care in 2009, with over $918 billion of that coming from the federal government. Under some estimates, up to 10 percent of that amount - no one quite knows for sure - might be lost to fraud. But the relationship between health care fraud and the U.S. health care system is far more complex than might first appear. Would-be "fraudsters" are not the only ones who respond to the financial incentives in the system. Due to the unique nature of the laws used to pursue health care fraud, both public and private prosecutors also follow the money in choosing their targets and both may share in the spoils of a successful prosecution. Perceptions about the money lost to health care fraud also have enormous influence on policymakers, as exemplified by the recent health care reform debate. In short, money may drive health care fraud, but not all roads lead in the same direction. This essay explores three different perspectives on the ways in which health care fraud "follows the money" - the would-be perpetrators of fraudulent schemes, the public and private prosecutors who pursue fraudulent activities, and the policymakers who work to prevent fraud and recapture lost funds for legitimate program purposes. Number of Pages in PDF File: 27 Keywords: Health Care, Health Care Fraud, Crime, White Collar Crime Accepted Paper Series

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