Annotated Bibliography: Medicare Fraud And Abuse Issues

Annotated Bibliography: Medicare Fraud and Abuse

Carolann Stanek

University of Mary

Annotated Bibliography:

DiSantostefano, J. (2013). Medicare Fraud and Abuse Issues. Journal for Nurse Practitioners, 9(1), 61-63. doi:10.1016/j.nurpra.2012.11.014 The author reviewed Medicare fraud and abuse, provided a simplified overview of common fraud and abuse issues, and listed helpful examples of each. Establishing these concepts is integral to the avoidance of corruptive activities in healthcare practices.

Furrow, B.R., Greaney, T.L., Johnson, S.H., Stoltzfus Jost, T., and Schwartz, R.L. (2015). Health Law (3rd ed.) St. Paul, MN: West Academic. ISBN: 978-0-314-28907-0

This text examined in-depth false claims and statements, bribes,

Roy is an example of physician liability in a Medicare fraud and abuse case. Because landmark penalties were enacted in regard to home health care fraud, this case is illustrative of the magnitude of Medicare infringement.

Government Publishing Office. (2017). United States of America vs. Johnny Trotter, II, M.D. and Elaine Lovett. Retrieved from https://www.gpo.gov/fdsys/pkg/USCOURTS-mied-2_14-cr-20273/pdf/USCOURTS-mied-2_14-cr-20273-6.pdf United States vs. Trotter and Lovett demonstrated how liability extends beyond a provider when Lovett, the owner of the billing company, was convicted of Medicare fraud and abuse. This case exemplifies how all workers within a healthcare system can be liable for the misuse of Medicare funds. Because of this, understanding the laws and regulations by healthcare workers is critical to ensure they are properly enforced.

Government Publishing Office. (2018). United States of America vs. Tracy Richardson Brown and Sandra Parkman Thompson. Retrieved from

There have been several Acts and programs initiated to reduce the fraud and abuse of Medicare, all of which are crucial efforts that aim to reduce misuse and positively contribute to the financial state of healthcare in the United States.

Robertson, B. (2011). Reporting and Returning Medicare and Medicaid Overpayments. Journal of Health Care Compliance, 13(5), 51-66. This report recommended actions an individual can take if they made a mistake in the claims process that results in an overpayment by Medicare. Because the claim filing and payment processes are both a human-involved processes, occasional mistakes are inevitable. However, the steps taken once those mistakes are identified are integral to avoiding penalties and violations of Medicare fraud and abuse.

Santo, C. (2014). Walking a Tightrope: Regulating Medicare Fraud and Abuse and the Transition to Value-Based Payment. Case Western Reserve Law Review, 64(4),