N - - 'Let's say you order blood work that we don't do. We bill Medicare for $100. We get paid $50. We give the patient $5. The more tests they agree towithout getting the needlesticks, etc., the more we all make. We can call it the Do-Good Clinic.\" He leans over and gives her a big hug. \"You are the smartest woman I've ever met Let's get started tomorrow!\" Ima sighs happily. This is going to be fike shooting ducks in a barrel. Discussion Questions 1. What laws, if any, are Gimme Moore and Ima planning to violate? 2. What obstacles do they need to overcome to make this work? 3. Why might their little plan be a big problem? Part | Six months later, the grand opening of the clinic is a big hit. Ima even has to run to the store to buy more turkeys to keep up with the demand. She now wears a shiny new diamond ring on her left hand. Gimme Moore hasn't left his wife, but the ring is a good faith gesture. She's certain it's only a matter of time before he dumps his ball and chain. Ima looks around at the crowds and the clinic. The building was a steal and business is taking off Life is good. Three months after the clinic opens, the receptionist, Ms. ltchy Palm, has referred many more people from the neighborhood to the \"clinic.\" Gimme Moore notes that many of them appear to be addicts and are thrilled to get cash on \"payday.\" Whatever. It's their lives. It's just business. Itchy approaches Gimme with a new business proposition. \"My cousin has a new drug clinic two blocks over from us. | was telling her about how well things were going here She asked me to ask you if you'd like to make some more money\" Gimme's all ears. That diamond ring cost a bundle and he had to hide the bill from his wife. He only did it to keep Ima guietand now she wants a fur, artwork, and a new condol If his wife finds out about Ima, she'll leave and take all her soon-to-be inherited properties with her. That real estate will be worth millions when his father-in-law kicks the bucket. \"Tell me more,\" Gimme says. 'My cousin said for every addict you refer to her, she'll give you ten percent of what she gets from Medicaid.\" [ell her to make it fifteen percent and we have a deal \" \"| will. And while we're at it, | want a raise. | deserve more than what you're giving me now.\" Gimme protests, \"You're overpaid now.\" \"You and Ima are a couple of con artists, and | want a bigger cut.\" ltchy smiles. \"Haven't you noticed there's an opioid epidemic? You're about to become very rich.\" Those who commit crimes, including fraud and abuse, need three things: Motive/Desire, Opportunity/Means, and Victims/Patients. Although Dr. Moore tells himself \"It's just a business,\" motivation to commit fraud and abuse includes, but is not limited to jealousy, greed, anger, financial difficulties, feeling underappreciated, and the thrill of a challenge. Discussion Questions What motives do you see in this case? What opportunities/means do you see in this case? Who are the victims of this fraud and abuse? What laws are Dr. Moore, Ima Greedy, and ltchy Palm violating? Are the patients violating any laws or are they victims? Who do you think will be most likely to turn Dr. Moocre into the authorities? Why do you think that person will do it? What regulatory agencies have jurisdiction over this case? Who should investigate this clinic? What are the potential penalties for Dr. Moore? For Ms. Greedy? For Ms. Palm? Should the patients be penalized? e U The Do-Good Clinic Case for Chapters 16 and 17 Sharon B. Buchbinder > Partl The very married Dr. Gimme Moore and his accountant/girlfriend-on-the-side, Ms. Ima Greedy decide they both should be earning more money than they are. The government, they decide while having a late-night romantic dinner, is taking too much money from them. As they whisper sweet nothings, they agree that they work hard, and they deserve to do better. Ima, who knows the laws regarding fraud and abuse, suggests they set up a real clinic with all the bells and whistles in a poor neighborhood with lots of people on Medicare and Medicaid who also are below poverty level and, for the most part, have not graduated from college. \"We can hire a receptionist who works in the neighborhood and can get us patients.\" Ima becomes excited. \"We can give them a referral fee in cash, so they won't be eager to rat us out. After all, they won't be paying taxes!\" Gimme Moore grabs her hand and says, 'Baby, | love it when you talk this way. What next?\" Ima blushes. Maybe he'll dump his wife if | come up with a really good plan? \"We have a grand opening around Thanksgiving and give away free frozen turkeys. The only way they get a turkey is if they sign up for physical exams.\" He squeezes her hand, \"Tell me more.\" \"When they come in, we give them a physical and go straight to the good part: would they like to earn some money? We'll give them ten percent of every test we get paid for. All we need is their Medicaid or Medicare numbers. We'll mix in some real tests, just to have something on the books, but the majority won't be.\" Gimme says, \"How will that work?\