Friday, October 28, 2011

Former Medical Equipment Supplier Pleads Guilty To Health Care Fraud

Little Rock - Christopher R. Thyer, United States Attorney for the Eastern District of Arkansas, announced today the guilty plea of Archibong Edem-Effoing, age 58, of Houston, Texas. Edem-Effoing pled guilty to one count of health care fraud in violation of Title 18, United States Code, Section 1347. At the plea hearing held before United States District Judge Brian S. Miller, Edem-Effoing admitted that no later than December 22, 2007 and continuing through March 1, 2009, he engaged in a scheme to defraud Medicare by stealing the identity of a young Nigerian which he then used to apply for a Medicare Durable Medical Equipment (DME) supplier number. After receiving the DME number, he billed Medicare for arthritis kits and power wheelchairs that, in some cases, were not ordered by a physician, and which in other cases were never delivered.

What is Single Payer

What is Single Payer?

Single-payer is a term used to describe a type of financing system. It refers to one entity acting as administrator, or “payer.” In the case of health care, a single-payer system would be setup such that one entity—a government run organization—would collect all health care fees, and pay out all health care costs. In the current US system, there are literally tens of thousands of different health care organizations—HMOs, billing agencies, etc. By having so many different payers of health care fees, there is an enormous amount of administrative waste generated in the system. (Just imagine how complex billing must be in a doctor’s office, when each insurance company requires a different form to be completed, has a different billing system, different billing contacts and phone numbers—it’s very confusing.) In a single-payer system, all hospitals, doctors, and other health care providers would bill one entity for their services. This alone reduces administrative waste greatly, and saves money, which can be used to provide care and insurance to those who currently don’t have it.

What is Single Audit?

Each year, the Federal Government provides over $400 billion in grants to State, local and tribal governments, colleges, universities and other non-profit organizations (non-Federal entities). The Single Audit Act of 1984 (with amendment in 1996) and OMB Circular A-133 ("Audits of State, Local Governments, and Non-Profit Organizations") provide audit requirements for ensuring that these funds are expended properly. All non-Federal entities that expend $500,000 or more of Federal awards in a year ($300,000 for fiscal year ending on or before December 30, 2003) are required to obtain an annual audit in accordance with the Single Audit Act Amendments of 1996 (pdf), OMB Circular A-133, the OMB Circular Compliance Supplement and Government Auditing Standards. A single audit is intended to provide a cost-effective audit for non-Federal entities in that one audit is conducted in lieu of multiple audits of individual programs. The Single Audit provides the Federal government with assurance that these recipients comply with such directives by having anindependent external source (the CPA) report on such compliance.

OMB Circular A-133 Compliance Supplement 2009