IIT Health Care Fraud United States of America Defendant & Appellant Case Study

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Health Medical

Indiana Institute of Technology

Description

For Module 4 Case Study you will review the following case "UNITED STATES of America, Plaintiff–Appellee v. Tariq MAHMOOD, M.D., Defendant–Appellant."

http://www.ca5.uscourts.gov/opinions%5Cpub%5C15/15-40521-CV0.pdf

After review of the case, compose a 3-5 paragraph response that accomplishes the following objectives:

  • Identifies the main issues/problems presented in the case
  • Analyzes the issues in detail, discussing potential factors that contributed to the case, and the effects of the issues on the viability of the provider.
  • Discusses the impact of the allegations and settlement on the health care facilities/system, patients and providers.
  • Discuss how an effective compliance program could help to mitigate risk of these types of incidences in the future.
  • Discuss any strategies or solutions that could be employed to prevent future incidences.

Your response should adhere to APA formatting and include a reference page when applicable.

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Explanation & Answer

Attached.

Running head: HEALTH CARE FRAUD

1

Health Care Fraud

Student’s Name
Institution Affiliation
Date

HEALTH CARE FRAUD

2

In the case of the United States of America vs. Tariq Mahmood, the main issues include
the fraudulent billing acts and aggravated identity theft performed by the defendant in his various
hospitals. According to the False Claims Act, the company carried out two forms of billing fraud:
billing for services not rendered and upcoding ("1. Health care fraud and its facilitating crimes,"
2017). In the allegation against billing for services not rendered, Mahmood manipulated one of his
coders, Crow, to submit re-sequenced codes from inpatient Medicare patients who had not re...


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