Health Care Fraud and Abuse 2020

Health Care Fraud and Abuse 


For this discussion, locate an article or a case that discusses a specific health care fraud and abuse case in the United States.

    • Provide the details surrounding the case.
    • Describe the role the government played in the case (federal, state, and local).
    • Analyze the effect on patient care, rights, or confidentiality.

You may want to start your research with the Office of Inspector General Web site, linked in the Resources.

Cite your sources as appropriate, using APA formatting.

Here is the link to the Office of Inspector General Website:



Medicare and Medicaid are insurance programs that enable the fair distribution of financial burdens of illness among the sick and healthy population and the low-income and affluent families. They cover aspects such as the doctor’s consultation, home care, and skilled nursing facility care. In general, it was established to aid the vulnerable individuals in the society to access medical services.

On Monday, July 10, 2017, the appropriate government officials including the acting United States Attorney for the Southern District of New York, Joon H. Kim, announced the unsealing of a criminal complaint charging SUNITA KUMAR with the operation of a health care fraud scheme. It involved the utilization of two pharmacies in Brooklyn, New York to defraud $9 million from Medicare and Medicaid (Petersons, 2017). This was a multi million-dollar scheme that involved the obtaining of prescriptions for medications, then through her pharmacies billed and received reimbursement from this social program. However, she failed to dispense them to the appropriate customers.

The Federal Government of the United States ensured the arrest of KUMAR and advocated for further investigations. The persons involved in this case included the following officials i.e. the acting Attorney for Southern District of New York, the Assistant Director-in-Charge of the New York Office of FBI, Special Agent in Charge of New York Regional Office for the Department of Health and Human Services, Office of Inspector General and Inspector General of the New York State Office of Medicaid Inspector General.In addition to that, these officials took the opportunity to educate and warn the masses of the adverse effects that would result from such actions. They also vow to work with law enforcement officers to pursue individuals who utilize the public programs to acquire illegal personal profit.

In conclusion, this social program is part of the patient care, rights and confidentiality package.  The exploitation of the state and federal health care programs threatens the health care industry as a whole and puts the economy at a significant disadvantage (Peloso,2002). It results in failure of the appropriate people from acquiring their medical rights. In addition to that, the citizen’s trust in the health care system diminishes, and this increases the mortality rates by 50%. Therefore, it is essential for individuals to comprehend the workings of this system and inform the necessary authorities.


Petersons, R. (2017). Brooklyn Pharmacy Owner/Operator Charged With Defrauding Medicare And Medicaid Programs Of Approximately $9 MillionJustice.gov. Retrieved 12 July 2017, from https://www.justice.gov/usao-sdny/pr/brooklyn-pharmacy-owneroperator-charged-defrauding-medicare-and-medicaid-programs

Peloso, J. (2002). Healthcare. New York: H.W. Wilson.