Antitrust and Fraud: Implications for Healthcare
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discussion3.docxAntitrust and Fraud: Implications for Healthcare
David Trapolsi
In this way, the documented goal of applying antitrust laws is the advancement of the free and open markets especially in creating competition in the healthcare sector. Such an instance is noted in the healthcare sector whereby, Section 1 of the Sherman Act is violated because it prohibits the collusive activities between the suppliers of drugs and the hospitals in a region (Showalter, 2017). In this case, the violations of horizontal price fixing are seen as one way of violating antitrust laws which result in poor competition and, in turn, the failure to control prices fairly among hospital in a region.
However, the violation of these antitrust laws is noted as a way of creating avenues for limiting free delivery of healthcare services by eliminating competition, which helps in the creation of value. In this case, when the healthcare organizations within a region use information jointly, and they try to control the prices of their services such as therapy as a form of treatment, it is evident that the antitrust laws will be violated and thus, the overall valuation competition will be ignored and eliminated from the healthcare sector.
References
Showalter, J. S. (2017). The Law of Healthcare Administration (Vol. Eighth edition). Chicago,
Illinois: Health Administration Press. Retrieved from
http://search.ebscohost.com.ezproxy.trident.edu:2048/login.aspx?direct=true&db=e000xn
a&AN=1839055&site=ehost-live
Antitrust and Fraud: Implications for Healthcare
Gloribel Torres
Oscar Huachillo, a former owner and operator of New York Health Clinics, were sentenced on Aug. 25, 2015, to 87 months in prison, three years of supervised release and was required to pay $3,454,244 in compensation and $31,177,987 in forfeiture, including forfeiture of around $14 million of possessions. Mr. Huachillo pleaded guilty to organizing a scheme to defraud Medicare out of more than $31 million and avoiding more than $3.4 million in federal income taxes by deceptively underreporting his income. Mr. Huachillo organizes and directed numerous health care clinics in the city of New York City that alleged provided medical treatment including injection and infusion treatments for HIV/AIDS patient under Medicare and Medicaid system. However, in reality, these medications were never given or were provided at highly diluted doses. Also, was often unnecessary for the reason that the person being “treated” did not medically need the treatments. Mr. Huachillo deliberately avoided over $3.4 million in taxes owed to the IRS from 2009 through 2011. According to the National Health Care Anti-Fraud Association (NHCAA) in “2011, $2.27 trillion was paid on health care, and more than four billion health insurance claims were processed in the United States.” It is an undeniable reality that some of these claims are fraudulent. Healthcare Fraud can cause an estimates financial losses due to health care fraud are in the tens of billions of dollars. Of these millions of claims, an insignificant percentage of them are illegal, but that slight percentage costs all U.S citizens and the U.S. government around 10 billions of dollars a year, thus leading to high payments and other out-of-pocket expenses for consumers, and lowered benefits or coverage.
Healthcare Fraud 2015 Update - Lorraine Gauli-rufo ... (n.d.). Retrieved from https://www.lgaulirufo.com/healthcare-fraud-2015-update/
The Challenge Of Health Care Fraud - The Nhcaa. (n.d.). Retrieved from https://www.nhcaa.org/resources/health-care-anti-fraud-resources/the-challenge-o
hreaded Discussion 3 - Week 1
Danielle Blassingame
In the case of St. Luke’s Health System, Idaho's largest hospital network, asked the Ninth Circuit Court of Appeals to reverse a federal district judge's January ruling. They were ordered to purchase Saltzer Medical Group in Dec 2012, a deal that would make them owning about 80% of physician practices in the area. This put them against their main competitor (St. Alphonsus Health, Idaho’s Attorney General and FTC). “Although nonprofit St. Luke's acquisition of the 40-doctor practice would have improved patient outcomes and general delivery of healthcare in the area, there were other ways to achieve this without violating antitrust laws and running the risk of rising costs, the lower-court judge said. The AG said state law prohibits acquisitions that would substantially lessen market competition. St. Luke's CEO David Pate recently told the Idaho Statesman the appeals court's decision could have broad implications on whether antitrust laws can bar health systems in small- and mid-sized markets from “tightly affiliating” with doctor groups to build new models of payment and delivery. St. Luke's argued the district court erred in anticipating anti-competitive effects from the deal.” (Packer-Tursman, 14). The U.S. District Court for the District of Idaho ruled that St. Luke's Health System must immediately begin separating its acquisition of Saltzer Medical Group while it appeals the separation order. Their motion to stay pending appeal was denied on the grounds that St. Luke was not likely to win on appeal and without a stay St. Luke's would have to begin removing Saltzer from their operations immediately. (Packer-Tursman, 14) This could have an impact on healthcare because you could lose a lot of really good providers in the merger.
Packer-Tursman, Judy (20 Jun 14). HealthCareDive. UPDATED: Two hospital antitrust cases you should be watching. (Retrieved on 4 Feb 19 from https://www.healthcaredive.com/news/updated-two-hospital-antitrust-cases-you-should-be-watching/275818/
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