Sketchy Heаlth Insurаnce Cоrpоrаtiоn (SHIC) is a Virginia-based health insurance company that offers insurance plans in the private health insurance market, on the state health insurance exchange under the ACA, and via Medicare Advantage (Medicare Part C). It competes with numerous other insurance companies across the state, but SHIC does most of its business in Northern Virginia where it insures roughly 30% of Medicare Advantage patients. Medicare Advantage is a program where the federal government pays private insurance companies to administer Medicare benefits. The idea behind this program is that private insurers have the experience and capability to coordinate Medicare benefits more efficiently than traditionally run Medicare (i.e. the federal government administers benefits and pays for care directly). The insurance companies that provide managed care plans under their Medicare Advantage agreements are considered to be federal contractors, at least for their Medicare Advantage business. Consider each scenario below and answer BOTH of them in isolation (i.e. don’t consider the facts provided in A. alongside those provided in B.!) A. SHIC knows that home-based care is reimbursed by the federal government at a much higher rate than physician office visits. Stella is a billing manager at SHIC, and has responsibilities to submit bills for payment to the federal government via the Centers for Medicare and Medicaid Services (CMS). She begins to notice a pattern of approvals where SHIC denies requests for office visits but then approves requests for home visits for the same patients. She believes the home visits are unnecessary but are approved because of the higher reimbursement by CMS. She confidentially informs the Office of the Inspector General of HHS (OIG) of her suspicions, and the OIG considers whether to file a complaint against SHIC. What FEDERAL statute might SHIC have violated by this billing practice, what must the prosecution prove for a successful prosecution (e.g. the requirements of the statute), and does the practice likely violate the statute? What is the technical term for the role that Stella plays and what is the benefit for her for informing the OIG at risk of her own job? (2-3 sentences) B. SHIC works with a number of third-party insurance intermediaries, which help Medicare beneficiaries decide whether to remain in the traditional Medicare program (parts A and B) or which Medicare Advantage plan to choose. SHIC approaches one of these intermediaries, Insurance for You, and proposes to pay $500 for each Medicare beneficiary it refers to SHIC Medicare Advantage plans. What FEDERAL statute might SHIC violate if this proposal is implemented, what must the prosecution prove for a successful prosecution (e.g. the requirements of the statute), and does the proposal likely violate the statute? (2-3 sentences)