White Collar Crime Exam 2

Front 1

Medicare

Back 1

Federally funded, Gives assistance to elderly

Front 2

Medicaid

Back 2

State funded, gives assistance to the poor

Front 3

Fraud

Back 3

Intentionally criminal behaviors by physicians, or other professionals, and abuse refers to overuse of medical services

Front 4

Phantom treatment

Back 4

Charges for services that were never provided by Healthcare providers

Front 5

Pingponging

Back 5

Medical patients are unnecessarily referred to other providers and bounced around various medical providers

Front 6

Ganging

Back 6

Situations where providers bill for multiple family members though they only treated one of them

Front 7

Kickback

Back 7

Occurs when providers direct patients to other providers in exchange or financial response from another provider

Front 8

Medical Snowballing

Back 8

Providers bill for several related services though only one service was provided

Front 9

Who is accused of most medical fraud?

Back 9

Psychiatrists and Psyhologists

Front 10

Explanations of fraud

Back 10

1. Structural explanations

2. Socialization factors

3. Cultural factors

4. Enforcement dynamics

Front 11

Structural explanations of fraud

Back 11

Structure of Medicare and Medicaid "Invite fraudulent activity"

Front 12

Social Explanations of fraud

Back 12

Focus on how students perceive medicare and medicaid. Students have less than favorable attitudes toward the programs.

Front 13

Health Insurance Portability Act of 1996

Back 13

Made health care fraud a federal offense. With penalties ranging from 10 years to life

Front 14

Most common fraudulent acts committed in Paynes 1995 study

Back 14

1. Fee for service reimbursement

2. Upgrading

3. Substitute providers

4. Double billing

Front 15

Top providers accused of fraud in Paynes 1995 study

Back 15

1. physician

2. Dentist

3. Podiatrist

4. Psychologist

Front 16

Unnecessary Surgery

Back 16

12,000 Americans Killed each year

Front 17

Medication Errors

Back 17

Occur when the healthcare providers deliver or prescribe the wrong meds to the patient

Harmful in 2 ways:

1. Patient is given drug he or she does not need, and drug could cause harm

2. Patient could receive harm from not getting the drug that is needed

Front 18

Questionable Doctors

Back 18

Collects data on physicians involved in misconduct

Front 19

Generic Drug substitution

Back 19

Pharamacist gave the customer a generic drug but billed the insurance company for a more expensive drug

Front 20

Short counting

Back 20

Occurs when pharmacists dispense fewer pills than prescribed but they bill the insurance company for all of the pills

Front 21

Double billing

Back 21

Pharmacists bills two or more parties for the same drug

Front 22

Billing for non existent prescriptions

Back 22

Pharmacists bill for prescriptions that dont actually exist.

Back 23

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