메뉴 건너뛰기




Volumn 51, Issue 2, 2011, Pages e3-

Pharmacy waste, fraud, and abuse in health care reform

Author keywords

Abuse; Fraud; Health care reform; Medicaid; Medicare; Regulations; Waste

Indexed keywords

ABUSE; FRAUD; HEALTH CARE POLICY; HEALTH CARE SYSTEM; HEALTH PROGRAM; HUMAN; LAW; MEDICAID; MEDICAL AUDIT; MEDICARE; MEDICATION THERAPY MANAGEMENT; NURSING HOME; PHARMACIST; PHYSICIAN SELF-REFERRAL; PRACTICE GUIDELINE; REMUNERATION; REVIEW; WASTE; ARTICLE; CRIME; GOVERNMENT; LEGAL ASPECT; PHARMACY; REIMBURSEMENT; STANDARD; UNITED STATES;

EID: 79959531562     PISSN: 15443191     EISSN: 15443450     Source Type: Journal    
DOI: 10.1331/JAPhA.2011.10168     Document Type: Review
Times cited : (2)

References (121)
  • 1
    • 84890922026 scopus 로고    scopus 로고
    • Department of Justice Accessed at July 1, 2010
    • Department of Health and Human Services, Department of Justice. Health Care Fraud and Abuse Control Program: annual report for FY 2001. Accessed at http://oig.hhs.gov/publications/docs/hcfac/HCFAC%20Annual%20Report%20FY%202001. htm, July 1, 2010.
    • Health Care Fraud and Abuse Control Program: Annual Report for FY 2001
  • 2
    • 84890951703 scopus 로고    scopus 로고
    • Department of Justice Accessed at July 1, 2010
    • Department of Health and Human Services, Department of Justice. Health Care Fraud and Abuse Control Program: annual report for FY 2002. Accessed at http://oig.hhs.gov/publications/docs/hcfac/HCFAC%20Annual%20Report%20FY%202002. htm, July 1, 2010.
    • Health Care Fraud and Abuse Control Program: Annual Report for FY 2002
  • 3
    • 84890949977 scopus 로고    scopus 로고
    • Department of Justice at 8-9. Accessed at July 1, 2010
    • Department of Health and Human Services, Department of Justice. Health Care Fraud and Abuse Control Program: annual report for FY 2006 at 8-9. Accessed at http://oig.hhs.gov/publications/docs/hcfac/hcfacreport2006.pdf, July 1, 2010.
    • Health Care Fraud and Abuse Control Program: Annual Report for FY 2006
  • 4
    • 84890956123 scopus 로고    scopus 로고
    • Department of Justice at 15. Accessed at July 1, 2010
    • Department of Health and Human Services, Department of Justice. Health Care Fraud and Abuse Control Program: annual report for FY 2008 at 15. Accessed at http://oig.hhs.gov/publications/docs/hcfac/hcfacreport2008.pdf, July 1, 2010.
    • Health Care Fraud and Abuse Control Program: Annual Report for FY 2008
  • 5
    • 84890960508 scopus 로고    scopus 로고
    • Department of Justice at 15. Accessed at July 1, 2010
    • Department of Health and Human Services, Department of Justice. Health Care Fraud and Abuse Control Program: annual report for FY 2009 at 15. Accessed at http://oig.hhs.gov/publications/docs/hcfac/hcfacreport2009.pdf, July 1, 2010.
    • Health Care Fraud and Abuse Control Program: Annual Report for FY 2009
  • 7
    • 84946871990 scopus 로고    scopus 로고
    • Improper Medicare FFS Payments Report
    • November at 57. Accessed at June 29, 2010
    • Department of Health and Human Services. Improper Medicare FFS Payments Report. In: HS's fiscal year 2009 agency financial report, November 2009, at 57. Accessed at www.hhs.gov/afr/2009sectii-financial.pdf, June 29, 2010.
    • (2009) HS's Fiscal Year 2009 Agency Financial Report
  • 9
    • 84890921035 scopus 로고    scopus 로고
    • H.R. 3590 (2010)
    • H.R. 3590 (2010).
  • 10
    • 84890923914 scopus 로고    scopus 로고
    • H.R. 4872 (2010)
    • H.R. 4872 (2010).
  • 11
    • 84890892679 scopus 로고    scopus 로고
    • Accessed at June 29, 2010
    • AARP Public Policy Institute. Attacking waste, fraud, and abuse in health reform. Accessed at http://assets.aarp.org/rgcenter/ppi/health-care/fs186- fraud.pdf, June 29, 2010.
    • Attacking Waste, Fraud, and Abuse in Health Reform
  • 12
    • 84890962109 scopus 로고    scopus 로고
    • 42 U.S.C. § 1395i(k)(8)(A) (2010)
    • 42 U.S.C. § 1395i(k)(8)(A) (2010).
  • 15
    • 84890902005 scopus 로고    scopus 로고
    • 42 U.S.C § 1395cc(j)(1)(A) (2010)
    • 42 U.S.C § 1395cc(j)(1)(A) (2010).
  • 16
    • 84890896621 scopus 로고    scopus 로고
    • Id. at § 1395cc(j)(2)(B)
    • Id. at § 1395cc(j)(2)(B).
  • 17
    • 84890953644 scopus 로고    scopus 로고
    • Id. at § 1395cc(j)(5)(A)
    • Id. at § 1395cc(j)(5)(A).
  • 18
    • 84890943971 scopus 로고    scopus 로고
    • Id. at §1395cc(j)(2)(D)
    • Id. at §1395cc(j)(2)(D).
  • 19
    • 84890956942 scopus 로고    scopus 로고
    • 31 U.S.C. § 3729 (2010)
    • 31 U.S.C. § 3729 (2010).
  • 21
    • 84890959510 scopus 로고    scopus 로고
    • 31 USCS § 3729(a)(1)(A)
    • 31 USCS § 3729(a)(1)(A).
  • 23
    • 84890904907 scopus 로고    scopus 로고
    • 42 U.S.C. § 1320a-7a(a) (2010)
    • 42 U.S.C. § 1320a-7a(a) (2010).
  • 24
    • 84890962630 scopus 로고    scopus 로고
    • Id. at § 1320a-7a(a),(8),(9),(12)
    • Id. at § 1320a-7a(a),(8),(9),(12).
  • 25
    • 84890900134 scopus 로고    scopus 로고
    • H.R. 3590 § 6402(a)
    • H.R. 3590 § 6402(a).
  • 26
    • 84890945310 scopus 로고    scopus 로고
    • 42 U.S.C. § 1320a-7b (2010)
    • 42 U.S.C. § 1320a-7b (2010).
  • 27
    • 84890949292 scopus 로고    scopus 로고
    • H.R. 3590 § 6402(f)
    • H.R. 3590 § 6402(f).
  • 28
    • 84890899960 scopus 로고    scopus 로고
    • 42 U.S.C § 1320a-7b(b)(1)-(2)
    • 42 U.S.C § 1320a-7b(b)(1)-(2).
  • 29
    • 0042079887 scopus 로고    scopus 로고
    • Pub. L. no. 105-33, title V, § 4301, 11 Stat. 251
    • Balanced Budget Act of 1997, Pub. L. no. 105-33, title V, § 4301, 11 Stat. 251 (1997).
    • (1997) Balanced Budget Act of 1997
  • 31
    • 77951918378 scopus 로고    scopus 로고
    • 760 F.2d 68 (3d. Cir. 1985)
    • United States v. Greber, 760 F.2d 68 (3d. Cir. 1985).
    • United States V. Greber
  • 33
    • 84890951703 scopus 로고    scopus 로고
    • Department of Justice Accessed at July 1, 2010
    • Department of Health and Human Services, Department of Justice. Health Care Fraud and Abuse Control Program: annual report for FY 2002. Accessed at http://oig.hhs.gov/publications/docs/hcfac/HCFAC%20Annual%20Report%20FY%202002. htm, July 1, 2010.
    • Health Care Fraud and Abuse Control Program: Annual Report for FY 2002
  • 34
    • 0042079887 scopus 로고    scopus 로고
    • Pub. L. no. 105-33, 111 Stat. 251
    • Balanced Budget Act of 1997, Pub. L. no. 105-33, 111 Stat. 251 (1997).
    • (1997) Balanced Budget Act of 1997
  • 36
    • 84890928724 scopus 로고    scopus 로고
    • 42 C.F.R. § 1001.952 (2010)
    • 42 C.F.R. § 1001.952 (2010).
  • 37
    • 84890920093 scopus 로고    scopus 로고
    • Id. at § 1001.952(d)
    • Id. at § 1001.952(d).
  • 38
    • 84890958867 scopus 로고    scopus 로고
    • at 2. Accessed at June 29, 2010
    • Centers for Medicare & Medicaid Services. Medicare fraud & abuse, at 2. Accessed at www.cms.gov/MLNProducts/downloads/ Fraud-and-Abuse.pdf, June 29, 2010.
    • Medicare Fraud & Abuse
  • 39
    • 84890918532 scopus 로고    scopus 로고
    • 42 U.S.C. § 1320a-7a(a)(12)
    • 42 U.S.C. § 1320a-7a(a)(12).
  • 40
    • 84890909646 scopus 로고    scopus 로고
    • 42 U.S.C. § 1320a-7b(g)
    • 42 U.S.C. § 1320a-7b(g).
  • 42
    • 84890946824 scopus 로고    scopus 로고
    • 42 U.S.C. § 1320a-7b(h)
    • 42 U.S.C. § 1320a-7b(h).
  • 43
    • 84890914797 scopus 로고    scopus 로고
    • 51 F.3d 1390 at 1400 (9th. Cir. 1995)
    • Hanlester Network v. Shalala, 51 F.3d 1390 at 1400 (9th. Cir. 1995).
    • Hanlester Network V. Shalala
  • 44
    • 84890964414 scopus 로고    scopus 로고
    • 42 U.S.C. § 1320a-7b(h)
    • 42 U.S.C. § 1320a-7b(h).
  • 46
    • 84890937540 scopus 로고    scopus 로고
    • 42 U.S.C. § 1320a-7b(g)
    • 42 U.S.C. § 1320a-7b(g).
  • 47
    • 84890910238 scopus 로고    scopus 로고
    • 42 U.S.C. § 1320a-7a(i)(6)(A)-(I)
    • 42 U.S.C. § 1320a-7a(i)(6)(A)-(I).
  • 48
    • 84890965069 scopus 로고    scopus 로고
    • Id. at § 1320a-7a(a)(5)
    • Id. at § 1320a-7a(a)(5).
  • 49
    • 84890925707 scopus 로고    scopus 로고
    • National Association of Chain Drug Stores. at 1. Alexandria, VA: National Association of Chain Drug Stores
    • National Association of Chain Drug Stores. NACDS coupons, rewards programs, and beneficiary inducements, at 1. Alexandria, VA: National Association of Chain Drug Stores; 2010.
    • (2010) NACDS Coupons, Rewards Programs, and Beneficiary Inducements
  • 50
    • 84890942988 scopus 로고    scopus 로고
    • 42 U.S.C. § 1320a-7a(a)(12)
    • 42 U.S.C. § 1320a-7a(a)(12).
  • 51
    • 84890958377 scopus 로고    scopus 로고
    • Id. at § 1320a-7a(i)(6)
    • Id. at § 1320a-7a(i)(6).
  • 52
    • 84890956584 scopus 로고    scopus 로고
    • Id. at § 1320a-7a(i)(6)(A)
    • Id. at § 1320a-7a(i)(6)(A).
  • 53
    • 84890920016 scopus 로고    scopus 로고
    • 67 Fed. Reg. at 55855.
    • Fed. Reg. , vol.67 , pp. 55855
  • 54
    • 84890925707 scopus 로고    scopus 로고
    • National Association of Chain Drug Stores. at 2. Alexandria, VA: National Association of Chain Drug Stores
    • National Association of Chain Drug Stores. NACDS coupons, rewards programs, and beneficiary inducements, at 2. Alexandria, VA: National Association of Chain Drug Stores; 2010.
    • (2010) NACDS Coupons, Rewards Programs, and Beneficiary Inducements
  • 55
    • 84890907617 scopus 로고    scopus 로고
    • 42 U.S.C. § 1320a-7a(i)(6)(F)
    • 42 U.S.C. § 1320a-7a(i)(6)(F).
  • 56
    • 84890893675 scopus 로고    scopus 로고
    • Id. at § 1320a-7a(i)(6)(G)
    • Id. at § 1320a-7a(i)(6)(G).
  • 57
    • 84890935021 scopus 로고    scopus 로고
    • Id. at § 1320a-7a(i)(6)(H)
    • Id. at § 1320a-7a(i)(6)(H).
  • 58
    • 84890924240 scopus 로고    scopus 로고
    • Id. at § 1320a-7a(i)(6)(I)
    • Id. at § 1320a-7a(i)(6)(I).
  • 59
    • 84890955404 scopus 로고    scopus 로고
    • Id. at § 1320a-7a(i)(6)(F)
    • Id. at § 1320a-7a(i)(6)(F).
  • 60
    • 84890932154 scopus 로고    scopus 로고
    • Id. at § 1320a-7a(i)(6)(G)
    • Id. at § 1320a-7a(i)(6)(G).
  • 61
    • 84890925707 scopus 로고    scopus 로고
    • National Association of Chain Drug Stores. at 3. Alexandria, VA: National Association of Chain Drug Stores
    • National Association of Chain Drug Stores. NACDS coupons, rewards programs, and beneficiary inducements, at 3. Alexandria, VA: National Association of Chain Drug Stores; 2010.
    • (2010) NACDS Coupons, Rewards Programs, and Beneficiary Inducements
  • 62
    • 84890963765 scopus 로고    scopus 로고
    • 42 U.S.C. § 1395nn (2010)
    • 42 U.S.C. § 1395nn (2010).
  • 63
    • 84890910465 scopus 로고    scopus 로고
    • Id. at § 1395nn(a)(1)
    • Id. at § 1395nn(a)(1).
  • 64
    • 84890925940 scopus 로고    scopus 로고
    • Id. at § 1395nn(a)(2)(A), (c)(1), and (d)
    • Id. at § 1395nn(a)(2)(A), (c)(1), and (d).
  • 65
    • 84890922471 scopus 로고    scopus 로고
    • Id. at § 1395nn(a)(2)(B) and (h)(1)
    • Id. at § 1395nn(a)(2)(B) and (h)(1).
  • 66
    • 84890919576 scopus 로고    scopus 로고
    • Id. at § 1395nn(h)(1)(C)
    • Id. at § 1395nn(h)(1)(C).
  • 68
    • 84890956417 scopus 로고    scopus 로고
    • 42 U.S.C. § 1395nn(h)(6)
    • 42 U.S.C. § 1395nn(h)(6).
  • 69
    • 84890899890 scopus 로고    scopus 로고
    • Id. at §1395nn(g)(3),(4)
    • Id. at §1395nn(g)(3),(4).
  • 71
    • 0032582885 scopus 로고    scopus 로고
    • 63 Fed. Reg. 58399 (1998).
    • (1998) Fed. Reg. , vol.63 , pp. 58399
  • 72
    • 84890928138 scopus 로고    scopus 로고
    • Accessed at July 16, 2010
    • Department of Health and Human Services. An open letter to health care providers: April 24, 2006. Accessed at http://oig.hhs.gov/fraud/docs/ openletters/Open%20Letter%20to%20Providers%202006.pdf, July 16, 2010.
    • An Open Letter to Health Care Providers: April 24, 2006
  • 73
    • 84890928138 scopus 로고    scopus 로고
    • Accessed at July 16, 2010
    • Department of Health and Human Services. An open letter to health care providers: March 24, 2009. Accessed at http://oig.hhs.gov/fraud/docs/ openletters/OpenLetter3-24-09.pdf, July 16, 2010.
    • An Open Letter to Health Care Providers: March 24, 2009
  • 74
    • 84890908367 scopus 로고    scopus 로고
    • H.R. 3590 § 6409
    • H.R. 3590 § 6409.
  • 75
    • 84890950208 scopus 로고    scopus 로고
    • Id. at § 6409(a)(1)
    • Id. at § 6409(a)(1).
  • 76
    • 84890925092 scopus 로고    scopus 로고
    • Id. at § 6402(b)
    • Id. at § 6402(b).
  • 78
    • 84890925013 scopus 로고    scopus 로고
    • Id. at 1
    • Id. at 1.
  • 79
    • 84890944776 scopus 로고    scopus 로고
    • Id. at 9
    • Id. at 9.
  • 80
    • 84890944648 scopus 로고    scopus 로고
    • at 1. Accessed at July 14, 2010
    • Government Accountability Office. Medicare recovery audit contracting, at 1. Accessed at www.gao.gov/new.items/d10143.pdf, July 14, 2010.
    • Medicare Recovery Audit Contracting
  • 83
    • 84890955526 scopus 로고    scopus 로고
    • Id. at 11
    • Id. at 11.
  • 86
    • 84890964500 scopus 로고    scopus 로고
    • Id. at 11
    • Id. at 11.
  • 87
    • 84890918340 scopus 로고    scopus 로고
    • The Medicare Recovery Audit Contractor (RAC) program: an evaluation of the 3-year demonstration, at 1. Accessed at July 14, 2010
    • Centers for Medicare & Medicaid Services. The Medicare Recovery Audit Contractor (RAC) program: an evaluation of the 3-year demonstration, at 1. Accessed at www.cms.gov/RAC/Downloads/DemoAppealsUpdate61410.pdf, July 14, 2010.
  • 88
    • 84890929083 scopus 로고    scopus 로고
    • Id. at 2
    • Id. at 2.
  • 89
    • 84890935230 scopus 로고    scopus 로고
    • Id. at 20
    • Id. at 20.
  • 90
    • 75449092597 scopus 로고    scopus 로고
    • Accessed at July 14, 2010
    • Federal Business Opportunities. Recovery Audit Contractor (RAC). Accessed at www.fbo.gov/index?s=opportunity&mode =form&id= c8c7d4b00249ba579d4d77d64bd0aea&tab=core&-cview=1&cck=1&au= &ck=, July 14, 2010.
    • Recovery Audit Contractor (RAC)
  • 91
    • 84890897819 scopus 로고    scopus 로고
    • Medicare recovery audit contracting, at 10. Accessed at July 14, 2010
    • Government Accountability Office. Medicare recovery audit contracting, at 10. Accessed at www.gao.gov/new.items/d10143.pdf, July 14, 2010.
  • 93
    • 84890913443 scopus 로고    scopus 로고
    • Medicare recovery audit contracting, at 10. Accessed at July 14, 2010
    • Government Accountability Office. Medicare recovery audit contracting, at 10. Accessed at www.gao.gov/new.items/d10143.pdf, July 14, 2010.
  • 95
    • 84890940735 scopus 로고    scopus 로고
    • Id. at 9
    • Id. at 9.
  • 96
    • 84890944648 scopus 로고    scopus 로고
    • at 40. Accessed at July 14, 2010
    • Government Accountability Office. Medicare recovery audit contracting, at 40. Accessed at www.gao.gov/new.items/d10143.pdf, July 14, 2010.
    • Medicare Recovery Audit Contracting
  • 97
    • 84890924773 scopus 로고    scopus 로고
    • at 1. Accessed at July 15, 2010
    • Centers for Medicare & Medicaid Services. RAC medical record request limits, at 1. Accessed at www.cms.gov/RAC/Downloads/ RAC%20Medical%20Record%20Request%20Limits.pdf, July 15, 2010.
    • RAC Medical Record Request Limits
  • 98
    • 84890955068 scopus 로고    scopus 로고
    • 42 U.S.C. § 1396a(a)(42) (2010)
    • 42 U.S.C. § 1396a(a)(42) (2010).
  • 99
    • 84890952493 scopus 로고    scopus 로고
    • 42 U.S.C. § 1395ddd(h)(3) (2010)
    • 42 U.S.C. § 1395ddd(h)(3) (2010).
  • 100
    • 84890894348 scopus 로고    scopus 로고
    • Id. at § 1395ddd(h)(9)
    • Id. at § 1395ddd(h)(9).
  • 102
    • 84890915416 scopus 로고    scopus 로고
    • at 2. Accessed at July 15, 2010
    • Bass, Berry, Sims PLC. Health law update: ZPICs: the new kids on the Medicare audit block, at 2. Accessed at www.bassberry.com/files/Publication/ d6df2eb5-6047-415c-af78-0298c8ff65f3/Presentation/PublicationAttachment/ 67be0c3f-0432-4634-aaae-03153c6eed18/HealthLawUpdate25022010.pdf, July 15, 2010.
    • Health Law Update: ZPICs: The New Kids on the Medicare Audit Block
  • 103
    • 84890896376 scopus 로고    scopus 로고
    • Accessed at July 15, 2010
    • Centers for Medicare & Medicaid Services. CMS integrity manual chapter 4: benefit integrity, page 11. Accessed at www.cms.gov/manuals/ downloads/pim83c04.pdf, July 15, 2010.
    • CMS Integrity Manual Chapter 4: Benefit Integrity , pp. 11
  • 104
    • 84890949363 scopus 로고    scopus 로고
    • Id. at 10
    • Id. at 10.
  • 105
    • 84890915416 scopus 로고    scopus 로고
    • Accessed at July 15, 2010
    • Bass, Berry, Sims PLC. Health law update: ZPICs: the new kids on the Medicare audit block, p. 3. Accessed at www.bassberry.com/files/Publication/ d6df2eb5-6047-415c-af78-0298c8ff65f3/Presentation/PublicationAttachment/ 67be0c3f-0432-4634-aaae-03153c6eed18/HealthLawUpdate25022010.pdf, July 15, 2010.
    • Health Law Update: ZPICs: The New Kids on the Medicare Audit Block , pp. 3
  • 106
    • 84890925634 scopus 로고    scopus 로고
    • Id. at 5
    • Id. at 5.
  • 108
    • 84859459673 scopus 로고    scopus 로고
    • 42 U.S.C. § 1395w-104(c) Accessed at: July 21, 2010
    • 42 U.S.C. § 1395w-104(c) (2010); Centers for Medicare & Medicaid Services. Medicare Part D medication therapy management (MTM) programs: 2010 fact sheet 1. Accessed at: www.cms.hhs.gov/PrescriptionDrugCovContra/Downloads/ MTMFactSheet.pdf, July 21, 2010.
    • (2010) Medicare Part D Medication Therapy Management (MTM) Programs: 2010 Fact Sheet 1
  • 109
    • 84890914856 scopus 로고    scopus 로고
    • 42 U.S.C. § 1395w-104(c)(2)(A)(i)
    • 42 U.S.C. § 1395w-104(c)(2)(A)(i).
  • 110
    • 84890953529 scopus 로고    scopus 로고
    • Id. at § 1395w-104(c)(2)(B)
    • Id. at § 1395w-104(c)(2)(B).
  • 111
    • 84890895001 scopus 로고    scopus 로고
    • 42 C.F.R. 423.153(c)(2) (2010)
    • 42 C.F.R. 423.153(c)(2) (2010).
  • 112
    • 84890960532 scopus 로고    scopus 로고
    • Id. at 423.153(d)(3)
    • Id. at 423.153(d)(3).
  • 113
    • 84890941855 scopus 로고    scopus 로고
    • Id. at 423.153(d)(2)(i)
    • Id. at 423.153(d)(2)(i).
  • 115
    • 84890905459 scopus 로고    scopus 로고
    • 42 C.F.R. 423.153(d)(2)(ii)
    • 42 C.F.R. 423.153(d)(2)(ii).
  • 116
    • 84890916660 scopus 로고    scopus 로고
    • 42 C.F.R. § 423.153(d)(2)(iii)
    • 42 C.F.R. § 423.153(d)(2)(iii).
  • 117
    • 84890899246 scopus 로고    scopus 로고
    • Id.; 42 C.F.R. § 423.104(d)(3)(iv)
    • Id.; 42 C.F.R. § 423.104(d)(3)(iv).
  • 118
    • 84890905079 scopus 로고    scopus 로고
    • HR 3590 § 3503(a) and (c)
    • HR 3590 § 3503(a) and (c).
  • 119
    • 84890898739 scopus 로고    scopus 로고
    • Id. 137. Id. § 3503(d)
    • Id. 137. Id. § 3503(d).
  • 120
    • 84890915032 scopus 로고    scopus 로고
    • 42 U.S.C. § 1395w-104(c)(2)(C)
    • 42 U.S.C. § 1395w-104(c)(2)(C).
  • 121
    • 84890943684 scopus 로고    scopus 로고
    • Id. at § 1395w-104(c)(3)
    • Id. at § 1395w-104(c)(3).


* 이 정보는 Elsevier사의 SCOPUS DB에서 KISTI가 분석하여 추출한 것입니다.