Sandra Parkman Medicare Fraud Case: Legal Violations and Penalties
Introduction
Given the vast and complex nature of the healthcare field, fraudulent activity persists. Although there are regulations and standards that were established to prevent illegal actions and deception, there are still instances when entities engage in deceptive schemes. One example of such circumstances is the case connected to Sandra Parkman, who was found guilty of Medicare fraud. After reviewing the case, it is evident that among the violated laws are the False Claims Act and the Anti-Kickback Statute.
Case Elements
The elements of the given case included multiple accusations made against Parkman. Parkman was found guilty on a single charge of conspiracy to engage in healthcare fraud, one charge of scheme to make payments and receive healthcare kickbacks, two charges of healthcare deception, and a total of five charges of accepting kickbacks in 2017, following a three-day jury trial (United States Attorney’s Office, 2018). Parkman engaged in a scheme aimed at deceiving Medicare between the years 2004 and 2009 by giving patients receiving Medicare surrounding New Orleans expensive medical supplies that were clinically unnecessary, such as power wheelchairs (United States Attorney’s Office, 2018).
Court Decision
Consequently, U.S. District Judge Kurt D. Engelhardt sentenced Sandra Parkman to over two years of prison and a fine (United States Attorney’s Office, 2018). Therefore, the decision reached by the court reflects the gravity of the fraudulent activity and how it affected other parties.
Types of Fraud
The type of fraud involved in this case is health care fraud, specifically Medicare fraud. Every segment of the healthcare industry is affected by fraud and abuse, encompassing drugstores, hospitals, doctors’ offices, wholesalers, distributors, testing facilities, and payers (Mackey et al., 2020). Payers—both commercial payers and government organizations like Medicare, Medicaid, and Tricare—are arguably the most severely damaged group (Mackey et al., 2020). They fall victim to annual healthcare claim frauds totaling billions of dollars (Mackey et al., 2020). Kickbacks, misleading claims, such as invoicing for services not performed, upcoding and providing medically inappropriate services, and illicit self-referrals are just a few examples of the various ways that fraudulent medical care can occur (Mackey et al., 2020). In the given case, the woman was found guilty of participating in a Medicare fraud and kickback scam.
Violated Laws
The laws broken in this case include the federal statutes related to health care fraud, such as the False Claims Act and the Anti-Kickback Statute. In addition to explicitly presenting false claims for administration reimbursement, healthcare organizations who conduct business with the U.S. government can additionally be in violation of the False Claims Act and Anti-Kickback Statute (McMichen, 2022). This is specifically true if they design schemes that trick other parties into providing fraudulent claims, whether on purpose or accidentally (McMichen, 2022). Given that the present scenario involves a deliberate deception of the system for personal benefit, the mentioned laws were broken.
Penalty and Appropriateness of the Outcome
The penalty and outcome for the perpetrator, Parkman, are reasonable. Sandra Parkman received a sentence of 32 months in prison along with a $277,197 reparation order (United States Attorney’s Office, 2018). The court decided the result of the case by considering the seriousness of the crimes committed into account. In addition to providing justice for the scam’s victims, the penalty is intended to discourage similar fraudulent activity in the future. As a result, the outcome is appropriate in order to promote compliance with regulations.
Role of a Corporate Compliance Program in Fraud Prevention
The final aspect that should be considered is that a Corporate Compliance Program can be a vital component in the healthcare field. Corporate compliance procedures have been established by healthcare businesses in an attempt to follow federal government guidelines, lower the possibility of improper behavior, and perhaps lower fines that could arise from a government inquiry (Cabar et al., 2023). A program like this usually consists of internal control systems, policies, and processes intended to identify and stop fraudulent activity (Cabar et al., 2023). It entails teaching staff members about the dangers of fraud, putting monitoring and auditing mechanisms in place, regularly assessing risks, and encouraging a compliance-focused culture within the company (Cabar et al., 2023). In such a case, by establishing the given program, it will be possible to identify and eliminate risks in healthcare organizations in a timely manner.
Conclusion
In summary, examining the case, it is clear that the Anti-Kickback Statute and the False Claims Act were among the laws broken. Among the case’s components were Parkman’s numerous charges. The severity of the fraudulent activities and how they impacted other parties are reflected in the court’s verdict. Medicare fraud is the particular kind of healthcare fraud that is at issue in this case. Since the current situation entails a purposeful manipulation of the system for individual gain, both the Anti-Kickback Statute and the False Claims Act suffered violations. For Parkman, the offender, the punishment, and the result are fair. The penalty aims to deter future fraudulent conduct along with offering justice to the victims of the scheme. Healthcare companies will be able to quickly identify and remove risk factors by implementing a Corporate Compliance Program.
References
Cabar, F. R., Oliveira, M. A., & Gorga, M. L. (2023). Healthcare compliance: Pioneer experience in a public hospital. Revista da Associacao Medica Brasileira, 69(2), 203–206. Web.
Mackey, T. K., Miyachi, K., Fung, D., Qian, S., & Short, J. (2020). Combating health care fraud and abuse: Conceptualization and prototyping study of a blockchain antifraud framework. Journal of Medical Internet Research, 22(9), 1-9. Web.
McMichen, G. (2022). False claims: The coordinated exploitation of the United States government by the healthcare industry. Journal of Law and Health, 36(1), 34–62. Web.
United States Attorney’s Office. (2018). New Orleans woman sentenced to prison for role in $3.2 million health care fraud and kickback scheme. Web.