Medical Fraud and Abuse -- Essay

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The facts that you have provided indicate extremely troubling circumstances that could seriously jeopardize the welfare of your organization. It is well-settled law that entities contracting for the services of subsidiaries are legally responsible for legal and ethical improprieties committed by those subsidiaries irrespective of whether or not the contracting organization had any specific involvement in or knowledge of those actions. Accordingly, we would strongly advise that you take immediate action to rectify the situations described in the manner outlined in our recommendations below.

Recommendations

To avoid the potentially serious criminal, civil, and financial consequences arising under MWHC's respondeat superior responsibility to prevent fraud and abuse in connection with its association with subsidiaries, it is hereby recommended that MWHC immediately:

1. Instruct the subsidiary to cease and desist from offering its contracted home health agency employees compensation of any kind in connection with client durable medical equipment (DME) orders from the subsidiary.

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2. Instruct the subsidiary to cease and desist from offering financial rebates to patients who use its equipment.

3. Instruct the subsidiary either to (1) expand its payment to hospital and home health agency personnel for assisting its patients in learning how to use all types and brands of similar medical equipment, or (2) cease and desist from offering any such financial incentives in that regard.

4. Determine whether any specific individual was responsible for deliberately altering or fabricating objective medical and terminate that individual for cause......

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