In this assignment we examine the legal and ethical implications of fraud and ab
ID: 413711 • Letter: I
Question
In this assignment we examine the legal and ethical implications of fraud and abuse with Medicare. Use the CSU-Global Library and the internet to identify a real-world case of Medicare fraud and/or abuse. Write a 4-5 page report using the readings, research, and your knowledge of health law and ethics to analyze this case.
Your report should address the following substantive requirements:
Description of what occurred, who was affected, and why
Assess the case from the following perspectives:
Ethical – identify the ethical principles involved in this situation from the perspective of all those involved.
Legal – what are the legal implications and what laws or statutes were involved?
Provide two recommendations for how to manage this case from the perspective of the healthcare organization involved. What could have been done to prevent this situation?
Recommend next steps to manage this case.
Your report should meet the following structural requirements:
Be 4-5 pages in length, not including the cover or reference pages.
Be formatted according to the CSU-Global Guide to Writing and APA Requirements.
Provide support for your statements with in-text citations from a minimum of four (4) scholarly articles. Two (2) of these sources may be from the class readings, textbook, or lectures, but two (2) must be external. The CSU-Global Library is a good place to find these references.
Utilize the following headings to organize the content in your work.
Introduction
Assessment
Recommendations
Conclusion
Explanation / Answer
Ans:Medicare is the federal program administered by the Centers for Medicare and Medicaid Services.
Fraud means attempting to obtain services or payments by dishonest means with intent,knowledge and willingness.
Examples are:A doctor bills for an initial visit but the visit was a follow up or A lab charges for blood tests but no tests were done or A supplier delivers a basic wheelchair but bills for a more expensive model
Abuse occurs when a provider bills for medically unnecessary items or services or when the services performed exceed what is needed.
Examples are Unnecessary home medical equipment or Excessive diagnostic x-rays and clinical laboratory services
Case study on Health Alliance of Greater Cincinnati and Christ Hospital kickback investigation settlement: In the year 2010,this hopital was accussed of illegaly paying physicians for referring cardiac patients. These references contributed 2% of hospital yearly gross revenues.Physicians were rewarded with a corresponding percentage of time at the Heart Station, where they had the opportunity to generate additional income by billing for the patients they treated at the unit and for any follow-up procedures that these patients required. A case was filed under false claim act.They were not focussing on needs of their patients but on financial interests of physicians. Christ hospital had to pay 108$billion to settle the claims.
Steps to prevent healthcare fraud and abuse:
a.Go to trusted sources
b. Keep personal information safe
c.Check charges for your medical care
d.Report suspected Medicare and abuse