Auditing, however, must extend beyond the written record to establish that the services were actually provided to the patient or client and that the services were rendered according to the conditions described in the provider's written record Harris, As the practice manager, I would remind the physician that every employee has a duty to cooperate and a duty of loyalty to the employer.
Fraud and Abuse Case Healthcare fraud and abuse continues to threaten the country, costing the facility billions of dollars per year. Brodeur, stated that fraud is something difficult to understand because it is a contagious issue.
Commonly Health care fraud essays of healthcare fraud and abuse cases are revealed where one bill for services not offered, up coding which refers to hiking bills with intention to get higher reimbursement increment. Unbundling which entails submission of separate bills for single component of an activity for example billing independently for categories of laboratory tests done together with the aim of getting high reimbursement.
These fraud activities are against compliance laws and regulations and it is unethical and immoral behavior. Recently I received a call on my hotline regarding a potential fraud and abuse that was taking place in an hospital facility, the compliant poured his grievances saying that one of their doctors was billing for services that had not been provided, he went on to stress that this behavior if not urgently addressed will lead to lose of reimbursement of Medicare and Medicaid.
Thorough investigation revealed that Medicare and Medicaid fraud and abuse cases are rampant in hospital facilities. Examination of the facility data done to enable identification of culprits, by doing this it alerted the facility to be informed of certain abuses and become the eye-opener to bring civil and administrative action against such facility and individuals concerned.
Statistical data over several years was also investigated and analyzed. From the interviews conducted whereby several bodies were involved for instance staff residents, the customers and management it Health care fraud essays that there was higher practices of fraud and abuse.
Some of the questions asked include forms of fraud and abuse cases practiced, different responses and reactions was experienced from the whistle blower, management and staff residents.
Some patients were interviewed concerning quality of services offered some were dissatisfied while others were satisfied this revealed that there was a problem that needed to be addressed. With the help of a whistle blower the name of the person suspected, Dr.
Greedy through thorough investigation revealed that he has really expanded his belly and robbed the facility quite a lot of money through his engagement in fraud and abuse by billing for services that had not been provided.
Greedy an ophthalmologist who billed for laser surgery he did not offer, as aspect of proof, laser equipment or access of such equipment at the place of services as stated in the form was nowhere to be found the date of service was blank indicating that no activity took place.
As proved that fraud and abuse cases have been going on action should be taken to safeguard losing reimbursement for Medicare and Medicaid programs. Greedy found to have a case to answer a disciplinary action will be taken for failure to comply with applicable laws and regulations he was eventually suspended.
Ethics and Morals The service providers have responsibility to maintain accurate and honest records relating to all services, to give out the correct billing of all payers and to follow all laws and regulations relating Medicare and Medicaid coding and billing practices.
All employees should conduct their activities in ethical, legal and competent manner According to Brodeur ethics are planned process of reflection in which issues of what one morally ought to do are scrutinized, evaluated and decided through moral reasoning that encompasses but not limited to principles and theories.
Ethical behavior is important in healthcare environment though human beings with their money minded attitude have tried to act contrary of what they are expected. The code of ethics in a hospital facility serves the following purposes: Establishes a set of framework for professional behavior and responsibilities when professional obligations or ethical uncertainties arise.
Enhancing accountability of the facility so that the public can rely upon Promotes high standards of hospital facility practice Summarizes large ethical principles that reflect the professions core values Some code of ethics principles and guidelines include: The practitioner should take an immediate action of reporting any unethical activities for example fraud and abuse undertaken by a colleague and if there is incompetence.
Positive representation of the profession to the public. Promoting the value of self-determination for each individual, the service provider should not look down upon or despise anyone.
Presenting valid credentials and rewarding where it deserves, that is biasness should be the thing of the past. Acting as an example.
Service providers are seen as mentors to the students, peers, and new health management professionals so as to be able to develop and strengthen skills. Ethical behavior in most facilities has been corrupted by individuals who are profit minded, this gives impression that something bad will happen for the ethical provision of healthcare services.
Failure of governing body to make sure that contractor of services furnishes services that enable hospital to comply with all laid down requirement of participation and standard of contracted services Failure of the hospital facility to take part in hospitals Continuous Quality Performance Improvement Program relative to general services, a lot of negligence and ignorance experienced.
Mishandling records whereby current and accurate records were not taken concerning the number of patients attended to and duration of services. The hospital did not reveal clearly the list of all contracted services, including the type and nature of the service provided.
Failure of the hospital to analyze and identify quality indicators including adverse patient period and other aspects of operation that aid in cure, hospital services and operations Lack of accountability from medical staff and administrative officials in ensuring quality improvement of the services provided is implemented and maintained.Collectively, the Department of Health and Human Services and the Department of Justice work to reduce healthcare fraud and investigate dishonest providers and suppliers.
The Health Care Fraud Prevention and Enforcement Action Team recouped almost 3 billion in fraud, this year alone. Also. Health care fraud not only costs our nation in terms of health care dollars and patient care.
It is one of the important factors that has contributed to the increasing cost of the health care services. Essay about Health Care Fraud Words | 9 Pages. Health Care Fraud: The typically overlooked crime of healthcare fraud has resulted in a significant monetary loss on the part of the American public paying into government run medical programs, as well as private insurance company programs.
Health care Fraud Health care fraud is a crime that has a significant effect on the private and public health care payment system. According to the Federal Bureau of Investigation, all health care programs are subject to fraud .
The Health Care Fraud Unit was established in to insure the success of investigations which have a national impact on the health care fraud crime problem.
Furthermore, their mission is to concentrate their investigative resources on. Healthcare fraud is a white-collar crime that usually involves filing health care claims by healthcare service provider to turn a profit for the healthcare service providers.
It involves “an unlawful act, generally deception for personal gain”, and encompasses a wide range of irregularities and illegal acts that are characterized by.