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Group 5 assignment

Group 5 Assignment
Across
The disclosure by a person, usually an employee in a government agency or private enterprise, to the public or to those in authority of mismanagement, corruption, illegality, or some other wrongdoing.
These improper payments can come in many different forms, including, but not limited to: referral fees; finder’s fees; productivity bonuses; discounted leases; discounted equipment rentals; research grants; speaker’s fees; excessive compensation; and free or discounted travel or entertainment
This section does not apply to claims, records, or statements made under the Internal Revenue Code of 1986.
When physicians, hospitals and other health care providers submit bills to government health care programs they are required to include a number of important certifications, including that the services were medically necessary, were actually performed, and were performed in accordance with all applicable rules and regulations.
Any information furnished pursuant to subsection shall be exempt from disclosure under section 552 of title 5.
Knowingly submitting a false claim to the government or causes another to submit a false claim to the government, or knowingly makes a false record or statement to get a false claim paid to the government
One common type of fraud has been for hospitals and particularly insurance companies, to discourage enrollment by persons they deem to be sicker or at higher risk for serious illness
having a natural tendency to influence, or be capable of influencing, the payment or receipt of money or property
Any documentary answers to written interrogatories or oral testimony provided under civil investigative demand
One common type of fraud has been for hospitals to inflate the costs on their Medicare Cost Reports, or to otherwise falsify the information on these reports to maximize its reimbursement.
Down
The person bringing a qui tam.
A person has actual knowledge, acts in deliberate ignorance of the truth, or falsity in respect to information
The submission of a claim for health care services, treatments, diagnostic tests, medical devices or pharmaceuticals provided to a patient who either does not exist or who never received the service or item billed for in the claim
The submission of a claim for health care services, treatment, diagnostic tests, medical devices or pharmaceuticals that was never rendered.
means an established duty, whether or not fixed, arising from an express or implied contractual, grantor-grantee, or licensor-licensee relationship, from a fee-based or similar relationship, from statute or regulation, or from the retention of any over payment.
One common type of fraud has been to submit claims for services, treatments, diagnostic tests, and medical devices that are not medically necessary
A demand for money or property made directly to the Federal Government or to a contractor, grantee, or other recipient if the money is to spent on the governments behalf and if the Federal Government provides any of the money demanded or if the Federal Government will reimburse the contractor or grantee.
occurs when a health care provider submits of a claim for health care services, treatments, diagnostic tests or items which represent a more serious and more expensive procedure than that which actually was performed
A suit filed by an individual on behalf of the government.