Criminal Cases in Health Care

Criminal actions in health care, such as patient abuse or defrauding payers, are serious transgressions and accordingly can lead to serious consequences.

For this Discussion, you will examine a criminal case in a health care setting similar to where you work or intend to work (such as a nursing home, hospital, or transitional care facility) and propose ways that a health care administrator can prevent this kind of crime.

To prepare for this Discussion:

Review Chapters 5 and 19 of Legal and Ethical Essentials of Health Care Administration for descriptions of criminal law in health care.

Do online research to find a legal case, journal article, or detailed news article describing a recent criminal case involving the kind of health care facility in which you are interested in working. The case you select may involve fraud and abuse (such as defrauding the Medicare or Medicaid programs, the Stark self-referral law, anti-kickback statute, or price-fixing) or other criminal act (such as patient abuse, murder, or theft).

A good source for cases is the Medicaid Fraud Control Unit. Consider looking through one or two state websites, which can be accessed through this page,, to locate a case.
Identify the laws that are involved in your selected case, and bring to mind the ramifications of this criminal action on the individuals and organizations involved.
Consider possible motivations behind this criminal act. What could an administrator do to prevent this from happening or to address it effectively once it is detected?
Review the description of compliance programs on page 117 of Legal and Ethical Essentials. Would a compliance program be of value in preventing or detecting and then correcting this criminal issue?
By Day 4, post a response to the following:

Briefly summarize the case you located, and provide a citation (and URL, if possible) for your source(s).
What are the specific legal issues involved? Who is liable?
What are the possible consequences to individuals and organizations in a case such as this?
Discuss the role of the administrator in preventing criminal acts such as these.
Do you think a corporate compliance program would help to address this issue? If so, explain how. If not, explain why you think it wouldn’t.

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