Medicaid Fraud

Medicaid Fraud HCS/545 July 9, 2012 Medicaid fraud comes in many forms. A provider who bills Medicaid for services that he or she does not provide is committing fraud. Overstating the level of care provided to patients and altering patient records to conceal the deception is fraud. Recipients also commit fraud by failing to report or misrepresenting income, household members, residence, or private health insurance. Facilities have also been known to commit Medicaid fraud through false billing.The Medicare and Medicaid fraud and abuse statute provides that an individual who knowingly and willfully offers, pays, solicits, or receives any remuneration in exchange for referring an individual for the furnishing of any item or service (or for the purchasing, leasing, ordering, or recommending of any good, facility, item, or service) paid for in whole or in part by Medicare or a state health care program (i. e. , Medicaid) shall be guilty of a felony; this is known as the â€Å"anti-kickba ck† statute (Mackelvie, 2004).Medicaid fraud affects taxpayers, recipients, and health care organizations. Measures to reduce Medicaid fraud are necessary. Individuals, facilities, and providers commit Medicaid fraud in several ways. One of the most common ways providers commit fraud is billing for services never provided. For instance, a physician may bill Medicaid for x-rays or lab work that the patient never received. Another way is double billing. Double billing occurs when both Medicaid and a private health insurance are billed for the same services.Medicaid is secondary health insurance to private health insurance and should be billed only for the charges that the primary health insurance does not pay. A third way providers commit Medicaid fraud is billing for phantom visits; charging Medicaid for seeing a patient who has not been seen. Providers have committed Medicaid fraud by billing for unnecessary tests and billing for more expensive procedures when a limited or les s comprehensive procedure was performed. Facilities such as pharmacies commit fraud by substituting brand name drugs for generic drugs and billing Medicaid for the brand name drug.Still other facilities receive kickbacks and file false cost reports. Kickbacks involve receiving payments or services for referral of patients to other facilities or providers where the patient will receive unnecessary services to generate additional income. False cost reports are seen in nursing home cases of fraud and involve owners filing charges for their own personal expenses. Individuals enrolled in Medicaid programs commit fraud by hiding resources, assets, and income.They also commit fraud by denying spouses live in their households or failing to report marriage to continue receiving Medicaid benefits. Individuals with private health insurance who fail to report this insurance and continue using Medicaid benefits are committing fraud. It is an abuse of the Medicaid program when individuals who cou ld obtain coverage on their own instead enroll in Medicaid to cover their medical expenses. Also the federal government stipulates that an individual cannot receive Medicaid in more than one state at the same time.Often, individuals move to another state and fail to report or close their Medicaid benefits with the state in which they were residing. Some individuals want to maintain coverage in more than one state because benefits differ from state to state and some individuals will travel between neighboring states using their Medicaid benefits. This constitutes Medicaid fraud. A program to fight Medicaid fraud has cost the United States at least $102 million in auditing fees since 2008 while identifying less than $20 million in overpayments, investigators found (Wayne, 2012).According to the National Association of Medicaid Fraud Control Units (2012), Medicaid provider fraud costs American taxpayers hundreds of millions of dollars annually and hinders the very integrity of the Medi caid program. Medicaid fraud affects recipients, providers, health care facilities, and taxpayers. Fraud increases the costs of providing benefits to Medicaid recipients. To compensate for such fraud, states must either raise taxes or decrease services in other areas. Those who most need Medicaid services may not be able to obtain benefits because resources are not available.For patients, Medicaid fraud could mean tampering with their medical records, which could put their health at risk. People can get hurt when doctors or other providers give less or more care than needed just to make more money. Also the public is more skeptical about social service programs as more incidents of Medicaid fraud occur every day. Providers and facilities who commit Medicaid fraud can face penalties from state and federal governments. Federal or state authorities may investigate allegations of fraud depending on where the fraud was reported, the laws broken, and the amount of money involved.The stric tness of penalties levied by state governments varies from state to state. Federal laws such as The False Claims Act, Anti-Kickback Statute, and Social Security Act are laws that address fraud and abuse. Title XI of the Social Security Act contains Medicaid program-related anti-fraud provisions, which impose civil penalties, criminal penalties, and exclusions from federal health care programs on persons who engage in certain types of misconduct (Staman, 2010).Under federal regulations, providers convicted of fraud are excluded for a minimum of five years from receiving funds from any federally funded health care program, either as a health care provider or employee (National Association of Medicaid Fraud Control Units, 2012). The False Claims Act imposes penalties on anyone who knowingly submits false claims for payment through a governmental program. Penalty for conviction under this Act is a fine not exceeding $10,000 or an imprisonment of up to five years, or a combination of the two (Centers for Medicare and Medicaid, 2011).The Anti-Kickback Statute makes it a criminal offense to knowingly and willfully offer, pay, solicit, or receive any remuneration to induce or reward referrals of items or services reimbursable by a Federal health care program (Centers for Medicare and Medicaid, 2011). Violations of this law are punishable by up to five years in prison, criminal fines up to $25,000, administrative civil money penalties up to $50,000, and exclusion from participation in federal health care programs (Centers for Medicare and Medicaid, 2011). There are other federal laws to address fraud and abuse of government programs such as Medicaid.These penalties are a reactive measure to control abuse of Medicaid, but proactive measurements are needed to discourage providers, individuals, and facilities from committing fraud. On October 27, 1977, President Jimmy Carter signed the legislation that provided each state with the opportunity and resources to establish a Medicaid Fraud Control Unit (MFCU) to investigate and prosecute provider fraud (National Association of Medicaid Fraud Control Units, 2012). The MFCU investigates Medicaid provider fraud and misuse of Medicaid recipients’ funds.The jurisdiction of the Medicaid Fraud Control Units is limited to investigating and prosecuting Medicaid provider fraud, MFCU’s do not investigate recipient fraud. States must also take initiatives to curtail fraud. Many states are looking to use new technology as a means to prevent fraud. One such technology is biometrics. Biometric technology compares a user’s feature such as a fingerprint. This technology has the potential to prevent recipient fraud by eliminating card sharing as well as preventing provider fraud by reducing phantom billing and other forms of fraud.New York, for example, has integrated targeted data mining and risk analysis into its fraud-fighting tool box. In Texas, a few simple process changes and new pattern analys is and recognition efforts moved the state closer to ‘real–time analysis’ and significantly increased the amount of fraud identified (National Conference of State Legislators, 2012). States must develop continually ways to prevent Medicaid fraud and protect the resources provided for recipients. Controlling Medicaid fraud will be a continual task.The burden falls not on just the federal government, but also state governments, facilities, providers, recipients, and citizens. States should fully commit to working with federal policymakers and agencies to improve the integrity of the Medicaid program. Clarity is needed to define federal and state government roles in maintaining integrity of the Medicaid program. Collaboration and communication between Medicaid and Medicare is needed to reduce fraud. States should evaluate the utility of existing tools used to fight Medicaid fraud. Incentives for providers, recipients, and citizens to report suspected fraud must be m ade available.Abuse of Medicaid affects everyone and costs will continue to rise if measures are not taken to use better the resources available in the Medicaid program. References National Association of Medicaid Fraud Control Units. (2012). What is Medicaid Fraud?. Retrieved from http://www. namfcu. net/about-us/what-is-medicaid-fraud Mackelvie, C. F. (2004). â€Å"The impact of fraud and abuse regulations – Medicare and Medicaid fraud and abuse statutes. Retrieved from http://findarticles. com/p/articles/mi_m3257/is_n10_v46/ai_13413481/pg_6/? tag=content;col1 Wayne, A. (2012). Medicaid Fraud Audits Cost Five Times Amount U. S. Found. Retrieved from

GIS – Harrow

For my report I've chosen 4 GIS maps from the Harrow council's official website (to make the results more reliable) that show the differentiation between the standards of living across the London borough of Harrow. The GIS maps that I chose (and copied as evidence) include: population density, life expectancy, street crime, and income levels; I have analysed them and described what the variations in each map are and what they show us. To conclude my report I have compared the variations in all the maps, and described what they show us. This map shows the main wards in the borough of Harrow. Pop. Density This map (see above) shows the population density levels in wards across Harrow. The map shows us that there is a mix of both high and low population density levels across the borough. The north east and west of the borough is the most sparsest, as it's got the lowest amount of people per hectare- 5-less than 40 people and 40-less than 55 High per hectare. Population density levels are more concentrated in the centre of the borough, where wards like Wealdstone, headstone north, Kenton west, and Marlborough are located, with equally high density levels spreading towards the south of the borough-towards the south east, where high pop. density levels are also highly concentrated, Kenton east is situated there. The south west of the borough has more of a mix of pop. density levels, as they're between mostly 40-less than 50 people per hectare, and 83-less than 107 people per hectare. (Wards like Roxbourne, and West Harrow which are situated in the south west of the borough have higher population density levels). Life expectancy This map (see above) shows the life expectancy levels in wards, across Harrow. The map shows us that the life expectancy levels across the borough are generally low- they're mostly around 78.5 years to less than 80 years, and 80 years to less than 81 years. The map shows us that generally the centre of the borough has got the lowest life expectancy levels in the borough, with a life expectancy of 76-less than 78.5 years and 78.5-less than 80 years. The areas with the highest life expectancies in the borough are the far north east where Cannons is located, with a high life expectancy of 81.5-less than 83 years, and the far south east, where Edgware is located, with a life expectancy of 81-less than 81.5 years. In general, I think that the graph shows us that the west-north /west of the borough has got the highest life expectancy, with mostly a life expectancy of 81.5-less than 83 years; the north-west has got a high life expectancy of 81-less than 81.5 years. Street crime-darker area=more street crime This map (see above) shows the levels of street crime in wards, across Harrow. The map shows us that generally, fairly high levels of street crime are quite widely dispersed across the borough, the fact that there is no legend available for this map makes it less reliable. The centre of the borough seems to have the most amount of street crime, as generally, there're darker areas are more concentrated, with Greenhill in the south having the highest level of crime as it is the darkest area. The whole of the eastern section of the borough also seems to have a high indicator for crime levels- where wards like Cannons and Edgware are located, as there're lots of dark areas and they're highly concentrated. The north/ west have got the lowest indicator levels for street crime, as there're a lot of light areas that are fairly highly concentrated, wards like Pinner, Hatch End, Headstone north, and Pinner south are located. Income-darker=less income, lighter=more income. This map (see above) shows us the levels of income in wards, across Harrow. The map shows us that generally fairly low income levels are widely dispersed across the borough, the fact that there is no legend available for this map makes it less reliable. The south of the borough seems to have a lower indicator level for income, as these areas are darker and highly concentrated, where wards like Greenhill, Marlborough, and Kenton are situated. Generally the east of the borough seems to have the low levels of income too (second after the centre). The north west section of the borough seems to have fairly low levels of crime as there are lighter areas, wards like Pinner, Hatch End, Rayners Lane, and Headstone north are located. Conclusion By comparing the 4 variations between the standards of living in Harrow for all 4 of the GIS maps, I have found that in general, the north west of the borough has got the lowest indicators for street crime, and population density, while having the highest indicators for life expectancy, and income. I think this is due to the fact that the categories may be interdependent. I think that because people in the north west generally have a higher income compared to the rest of the borough, so this could've had an impact on the other results from the other categories, e.g. the reason why there is a low indicator for population density in the area could be because the house prices are higher in this area, so people can't really afford to live in this area (as the majority of the rest of the borough seem to generally have a lower income level). Also, the results suggest that street crime levels are generally low in this area because of the low indicator of population density in this area. I have also found that in general, the south/west of the borough has got the highest indicator for population density levels, street crime levels, low income levels, and a low indicator for life expectancy levels. I think that this is due to the fact that the categories may have a correlation. I think that because people in the north west generally have a high indicator for population density levels, as they may have a low income compared to the north west of the borough (which has a high indicator for income), so they can't really afford to live in the north west, this could also be the reason why generally street crime levels are higher in the south east, because of the high indicator for population density. Also, the reason that the area in general has a low indicator for life expectancy may be because of the larger amount of people who live there.

What Is the Average SAT Score for Colleges

What Is the Average SAT Score for Colleges SAT / ACT Prep Online Guides and Tips If you're preparing for the SAT or have received your SAT scores, you may be wondering what score you need to get into college. What's an average SAT score for colleges? In this article, I'll explain average SAT scores and what they mean for you. Find out how to calculate the score you need to help reach your college goals. What Is the Average SAT Score for Colleges? Each year, the College Board reports the average SAT scores for college-bound high school seniors who take the SAT. Generally, the mean section score is around a 500. These are the most recent national SAT averages for the SAT in 2018: Evidence-BasedReading and Writing:536 Math:531 Total:1068 If you score a 1100 or better, you'll have a higher score than more than 50% of college-bound high school seniors. How to Find the Average SAT Score of a Specific College While you may want to know how your SAT score stacks up against others who take the test, what really matters is how your score compares to other applicants of the colleges you apply to. Even though a 1350 will be well above the national average, a 1350 is significantly below the average SAT for Ivy League schools. So although a 1350 is a very good score, you’ll be at a competitive disadvantage if you apply to any Ivy League school with a 1350. Conversely, if you apply to Cal States, a 1350 will exceed the average of any California State University campus, and you’ll improve your chances of getting accepted if you get that score. You can find the average SAT scores of different colleges in the PrepScholar database.Just google â€Å"prepscholar (name of school) SAT† to find a school’s profile. On the school profile, you can check out its average GPA, average SAT score, and acceptance rate. Scroll down to look for thenewSAT score- we've calculated it for you! According to the PrepScholar database, the average new SAT score for Princeton is 1520. For Ohio state, the average SAT score is 1330. Mark Kesling/Flickr What Does the Average SAT Score of a College Mean to You? If you want to get into a certain school, your SAT score should be comparable to the average score for the college’s admits. To give yourself the best chance of gaining admission to a specific school, we recommend that your goal should be to get at least a 75th percentile score for that college. The 75th percentile score for Princeton is 1590. Therefore, if you want to go to Princeton, your target score should be a 1590. Because Princeton's acceptance rate is only around 7%, you should try to comfortably exceed its average score to gain admission. Similarly, the 75th percentile score for Ohio State is a 1440. If you want to be an Ohio State Buckeye, you should be aiming for at least a 1440. What If You Don’t Get Your Target Score? If you don’t get the 75th percentile score or even the average SAT score for a specific college, that doesn’t necessarily mean that you have no chance to get admitted. However, if you still have time to reach your target score, it’s probably in your best interest to study and attempt to improve your score. You can compensate for lower test scores with a higher GPA. Generally, schools place a greater emphasis on your transcript than on your standardized test scores. On each school’s profile in the PrepScholar database, you can use our admissions calculator by entering your GPA and SAT score to get a rough estimate of your chances of gaining admission to that school. Also, keep in mind that colleges tend to use holistic admissions, meaning that everything is considered when colleges determine whom to accept. They’ll evaluate your transcript, test scores, extracurricular activities, recommendations, application essays, and any other factors that admissions officers deem relevant. If you've faced any significant obstacles, colleges will also take this into account. Just because you don’t reach your target score doesn’t necessarily mean that you have no chance to get admitted. However, while most colleges don't claim to have a minimum SAT score, if your score isn't close to the average score for a particular school, you may have virtually no chance of getting accepted. Even if you have great grades and stellar extracurricular accomplishments, you probably don't have a realistic shot of getting into Harvard if your SAT score is lower than 1080 (the average for college-bound seniors). While standardized tests aren't the only determining factor in college admissions, most colleges use the SAT to ensure that you're capable of succeeding academically. Do your best to get your target score! What's Next? Not sure where you want to apply to for college? Read our handy guide to help narrow down your college choices. Now that you're familiar with the average SAT score for colleges, learn more about minimum SAT scores for colleges. How do things look different if you're thinking of taking the ACT? Find out the average ACT scores for college here. Want to learn more about the SAT but tired of reading blog articles? Then you'll love our free, SAT prep livestreams. Designed and led by PrepScholar SAT experts, these live video events are a great resource for students and parents looking to learn more about the SAT and SAT prep. Click on the button below to register for one of our livestreams today!

Gwendolyn Brooks essays

Gwendolyn Brooks essays Gwendolyn Brooks is the female poet who has been most responsive to changes in the black community, particularly in the communitys vision of itself. The constant in Brooks poetry has been her loyalty to characters who find themselves trapped in an environment scarred by racial discrimination, poverty, and violence. Gwendolyn Brooks, the daughter of David Anderson Brooks, the son of a runaway slave, and Keziah Corinne (Wims) Brooks, was born on June 7, 1917, in Topeka Kansas. Brooks was the first African-American to win a Pulitzer Prize for poetry in 1950, and the first African-American woman to be inducted into the National Institute of Arts and Letters. The Brooks family moved to Chicago shortly after her birth. Her parents set a high priority on literature, and she began to collect her poems in notebooks at age eleven. Gwendolyn had a difficult time in school and was rejected for her shyness as well as her skin Brooks attended Hyde Park High School, the leading white high school in the city, but transferred to the all-black Wendall Phillips, then to the integrated Englewood High School. In 1936 she graduated from Wilson Junior College. These four schools gave her a perspective on racial dynamics in the city that continued to influence her work. Brooks was influenced at first by the Harlem Renaissance. Her early work featured the sonnet and the ballad, and she experimented with adaptations of conventional meter. Later, development of the black arts movement in the sixties, along with conceptions of a black aesthetic, turned her toward free verse and an abandonment of the sonnet as inappropriate to the times. However, she retained, her interest in the ballad, its musicality and accessibility, and in what she called "verse journalism." Brooks died in December 2000. Brooks writing is objective, but her characters speak for themselves. She uses ordinary speech. ...

Network Routing Assignment Example | Topics and Well Written Essays - 2500 words - 1

Network Routing - Assignment Example In this algorithm, whenever a status of the link changes, a routing update is exchanged between the routers; this routing update is called a Link-State Advertisement (LSA).   When routers receive this LSA routing update they recalculate the shortest path using link-state protocols to affected destinations.   Link-state routing constantly tries to keep complete networks topology by updating its routing table whenever a status of any link is changed in the network. Every router builds a map of the full network topology. OSPF (Open Shortest Path First) is an example of Link State protocol.   Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  In distance vector protocols, routers are updated about remote networks with the help of neighbouring routers using Bellman Ford algorithm. The distance part defines the total number of hops towards the destination, while in highly developed routing protocols these hops can be weighted by components such as delay and bandwidth available. The vector in distance-vector describes which hop to move as the next step along the direction (path) for this route. This routing information is passed on using neighbouring routers with routing table up to date by using update packets. The requirement here is to design a network for an International Travel Agency that has a HQ in London and its two remote branches in Paris and Rome. An open standard dynamic routing protocol is required for the communication between all the routers. Configuration of routing protocol on all the three sites must be as per the requirement advertisement of routes to all directly connected networks except the loopback interface attached to London HQ. Network design for an International Travel Agency (ITA) is demonstrated in this report. Head Office of the ITA located in London, United Kingdom, and it is connected with branch offices at Paris and Rome. The Headquarters are directly connected with both the branches while both

Information System Development Essay Example | Topics and Well Written Essays - 2000 words

Information System Development - Essay Example System developers can create new systems according to the needs of users on request or they can have foresight and anticipate users’ needs then create systems with this in mind (Whetten 2002, p. 45-71,). As systems are created by human beings, they cannot be entirely perfect, but trying to reach perfection and minimizing errors should be priority when creating systems. This is because users tend to move on fast from systems that are prone to failures, errors and mistakes, thus running the reputation of firms creating such systems and wasting time and money. With this in mind, system developers should strive to get as many details as possible about users’ needs in order to create systems in line with their needs, and one that works efficiently to meet these needs and requirements. Development of systems usually follows a systematic set of steps in order to ensure that systems produced work in accordance with the way they were supposed to. Missing any step in the developm ent might lead to errors that could easily be avoided. These steps also make it easy to pinpoint where mistakes have been made, hence it is easy to go back and rectify the errors, rather than tearing down the whole system to find the error. The order of steps in system development begins with a feasibility study to determine if the system is worth creating in the first place or not. After the worthiness of the project has been established, the planning process is next. Planning involves setting goals, timelines and determining all the necessities required in order for the project to be carried out successfully. Planning also involves coming up with a budget, creation of a team that will be in charge of the project, assigning of duties to the various team members, determining the chain of commands and to whom progress of the project will be reported, determining external; players and partners and the parts they will be playing in the project and sorting out other details. Failing to plan on any aspect touching the development of a system will have disastrous effects on the whole project (Blanchard & Fabrycky 2006). Systems analysis is a step that involves looking into the current systems in order to determine what users want that is not in these systems, then going ahead to create systems that give users what they need and require. After this has been determined, the system has to be designed, with the needs of users in mind and other anticipated needs (Caspi et al. 2005). In the designing of the system, several aspects are considered including detailed descriptions of its main features and how they work, screen layouts, business principles, legalities involved and other forms of documentation. This part is where the load of the work lies. After this is the implementation stage. Here, the code that is unique to the system being built is written. Code writing involves various numerical, alphabets and symbols that should not be easy to crack or identify by unauth orized users or authorities. Next is the integration of all the various separate parts of the system, as developed by the different people in the team, in order to make a whole part. The integration step involves the setting up of the system and testing it in order to determine if the end product is as required, to check for errors and potential weak points that might lead to the system not operating. Any errors found are rectified at this stage, and the

The Royal British Legion Essay Example | Topics and Well Written Essays - 2500 words

The Royal British Legion - Essay Example It was this royal charter which gives the Legion the prefix 'Royal' in its title. Till date, the Legion is principally a campaigning organization which promotes the wellbeing and welfare of presently serving and retired members of the British Armed Forces. The first campaign of the Royal British Legion pertained to the campaigning for War Disablement Pension cases for war veterans. At present, campaigns of Royal British Legion which are ongoing include advocating for increased research into psychological conditions of  Gulf War syndrome  and for enhanced compensation for the victims of the war. Other campaigns by the organization include upgrading of War Pensions; the expansion of endowment mortgage payment for British military personnel that are serving outside the country. The key objective of the organization is better provision for support of British military personnel that are facing difficulties in resettling back into civilian life. One of the most successful campaigns of the organization is the one in which the Legion organized a fund-raising drive weeks before  Remembrance Sunday. During the course of this campaign supporters of the war veterans were required to wear artificial  red poppies on clothing. It was announced that the proceeds from the sales of the artificial poppy flowers will be donated to charity. Appeals for Charity The organization can use a number of appeals for raising charity. Two forms of marketing objectives can be relevant to this organization. The first one relates to recruitment of volunteers, the second one relates to collection of charity for the objectives of the organization. To increase inflows of charity funds to the organization, the Royal British Legion can organize a festival to commemorate celebrate war veterans. It is proposed that most parts of this festival should be composed of formal. The event can generate revenue for the organization through sale of the attendance tickets or sale of items related to cele brated wars. These wars can depict civilian life during wartime or based on similar themes. Such an event is likely to generate high attention of the prospective target market because it will enable viewers belonging generations that were born after these historic wars – for instance, the World War II – to benefit from the affirmative engagements of those people who want to relive glorified history of the nation. Another appeal for charity which can be used by The Royal British Legion is the support for foreign troops of United Kingdom who are engaged in military combat. The organization can launch an ‘Honor’ campaign which can call on the citizens of United Kingdom both within country and abroad to honor the  military men protecting country’s interest in foreign lands like Afghanistan (Beamish and Ashford, 2009). The objective of the campaign would be gather public support for the issues recognized by the Legion and to promote interests of milita ry men abroad. The same campaign can be used to create support of the federal government, as well, for the troops and to influence government to create laws which are beneficial for the interest of these men. One aspect of this campaign can be seeking priority treatment for military men in hospitals rather than having them to wait for treatment in national institutions. ‘Online Assistance of Military Men’ can be a campaign which can