Healthcare Fraud papers

Healthcare Fraud

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Introduction

Background Information

On August 2009, FBI agents arrested Detroit residents who were linked to a healthcare plot of defrauding Medicare for more than 14.5 Million. Another Couple in Texas Houston was charged under Healthcare Fraud.  Culprits were area doctors and his wife the physician. They were charged in a federal court for prescribing more than 600000 pain pills and billing the government for more than eight million dollars, (Suleiman, 2009).  Healthcare Fraud has led to the presentation of charges for organization against the false medical, treatment or diagnosis histories. Organizations can be charged for Healthcare Fraud in the discovery of a continuous fraud scheme.  Organizations are charged for healthcare fraud due to the actions or intentions for stealing the patient’s health insurance benefits.

Other cases of Healthcare Fraud have been on the medical identity theft.  Wrong medical treatments have assured the success and control of procedures in the organization. The focus of the Medicaid and Medicare are the usual disclaimers for the Healthcare Fraud,(Assay, 2009). The healthcare fraud is presented with different healthcare scammers. Intentions to scam people for healthcare services have posed the danger of Fraud.  States with dishonest healthcare providers increase the problem of Healthcare Fraud.  The Healthcare Fraud can consist of the different wrongdoings for the entire population of the nation’s patients or the range of potential medical conditions.

Scope:

 The article will evaluate the problems brought by the Healthcare fraud. The discussion section will require the evaluation of the corporate structure and governance. Corporate responsibility requirements will base the need for controlling the Healthcare Fraud. Analysis section will evaluate the possible changes to the organizational culture, governance and structure.

Purpose:

Research aims increase the awareness of Healthcare Fraud in healthcare institutions.

Thesis:

Healthcare institutions will benefit from the management of Healthcare Fraud.

Discussion

Problems

             The problem of Healthcare Fraud can occur in the following states.  Billing Healthcare services that were not rendered can constitute to Healthcare Fraud.  Manipulation of the genuine patient information and allowing patient’s theft allows the fabrication of the entire claims for revenue that were not paid.  Secondly, Billing of services with a high cost can constitute to the problem of Healthcare Fraud, (Elkin, 2009).  Up coding of bills or falsifying of documents affects the state controlling procedures that are not necessarily offered. Medicare providers can follow the false procedural codes that are not true. Thirdly, the healthcare providers can be charged for the state of offering unnecessary services. Intentions to gain funds from the illegal practices constitute to Healthcare Fraud. Fourthly, the falsification of the patient’s diagnosis to justify the tests and surgeries will affect the medically necessary procedures. Fifth case is when unbundling of bills and offering different steps for the same conditions.  Cases of Healthcare Fraud will affect the profitability of the organization in handling the required tasks for assessment.

             Healthcare Fraud posts a problem or conflict between the management and the stakeholders.  Poor productivity can culminate in the organization due to Healthcare Fraud. Lack of equity in services providence will increase the executive salaries, reduce comparable worth of the organization and the competitors and increase the product pricing. The effects will destroy the performance of the organization, (Assay, 2009). Healthcare Fraud problems can lead to reduced whistle blowing, reduced employee diversity, increased sexual harassment or lack of respect for the corporate due process. Trust between the organization and the stakeholders will diminish due to destroyed reputation. Lack of honesty on the management of the data and records will affect the state of control for the organization. An assessment of the valuation will help in the control of the possible problems erupting within the organization. The stakeholders will expect questionable healthcare practices for the assessment of the different valuations and assessments, (Suleiman, 2009). Healthcare Fraud will affect the presentation of the exercise of the corporate power. Political deed committees, workplace protection, product safety, ecological issues and divestment of interests can allow the control of the activities for the organization.

Impact

             The Healthcare Fraud indicates the state of failure for the organization to respect the corporate social responsibilities.  Healthcare institutions are liable to stiff penalties and imprisonment of the masterminds of the Healthcare Fraud schemes.  Healthcare Fraud will reduce stakeholder’s trust upon the healthcare institution, (Assay, 2009).  Healthcare institutions are required to act in accordance to the values and objectives assuring a desirable state of obligation for the business enterprises.  Destruction of the corporate reputation will affect the ability of the organization to retain the employees for the institution. Corporate structure and governance are required to exercise the freedom and decide to be socially responsible. Healthcare governance will require the management of the business with the tension of the corporate social responsibility model, (Elkin, 2009). Corporate social responsibilities require the management to take the responsibility of going above and beyond the issues required the management to do.  The organizational culture will be expected to change in the elimination of the different loopholes offered by the operations of the employees in the organization.

 Loopholes of computer fraud, theft of stocks from healthcare stores, deliberate nonperformance, payment or invoicing fraud payments, procurement or contracting of fraudulent claims and supporting of fraudulent claims for bids should be eradicated. An assessment of the activities for the management will assure the control of activities for the management and the institution. Equality and liberty control for the institutions affected the state of success for the different institutions. Nationalists who are within the economic activities are required for the control of the state of success for the organization, (Assay, 2009).  Corporate social responsibilities will help in the adherence to the rules of the organization and the control of the quality and productivity of the organization.  Corporate social responsibilities will help in the reduction of the regulatory oversight and access to the capital markets.

Resource allocation

             Different resources are required for the prevention of the healthcare fraud. Firstly, the management should invest in the awareness and promotion of the customers awareness on the protection of their healthcare insurance ID, (Suleiman, 2009).  Organization of number of people handling payments should be reduced for fast assessment of responsibilities and Healthcare Fraud controls.  Workshops should be prearranged to augment the awareness of the nurses and physicians on the possible outcomes of catching a person with healthcare Fraud. Secondly, patients should be charged with the responsibility of reporting a fraudulent suspicion for their health insurance.  Insurers can offer the reports for suspecting the frauds online through the websites,(Elkin, 2009).  Thirdly, healthcare records and protection mechanisms should be updated. The electronic or digital records should be encrypted to allow the success of the organization for the achievement of the organizational success. Fourthly, pamphlets will be needed to sensitize on the need for the patients to read the benefits and policy statements. The medical bills receipt and questioning of the suspicious expenses will help in the generation of the effects for the organization.

Analysis

Expected changes

            The expected changes for the culture, governance and structure will be as follows. Firstly, the management should control the state of offering the inaccurate date of services, (Suleiman, 2009). The approaches will require the assessment of the discharge dates accuracy and admission checks. Healthcare structures should reconcile records early, run reports of checks in operating rooms and prevent irregularities in the records or billings. Secondly, the management should avoid charging incorrect room charges. Setting of the formal policies and procedures o charging will eliminate the problem of the organization, (Assay, 2009). An accurate document or private room checks will be assessed for the control of the state of room charges.  Management will monitor and establish the variances for the standards of performing activities. Thirdly, the management should avoid the keystroke errors or cancelled work.  Organizational culture should be changed to discourage errors and communicate cancelled works.  Another issue is on the measures to control up coding.

Conclusion

In conclusion, Healthcare institutions will benefit from the management of Healthcare Fraud.  Healthcare institutions can reduce their stress and fear of Healthcare Fraud in all the recommended changes. Changes in the corporate structure and governance will increase the state of profitability, access to funding and high-business valuations. An increased respect for the business community will be achieved by the healthcare institution through the implementation of CSR approaches. Reputational harm for the organization will be reduced largely. The management will be able to increase the employee’s loyalty in the performance of duties.

Reference

Assay, S. (2009). The Process of Whistle-blowing in a Psychiatric Hospital: Elsevier Publication: Journal on Nursing Ethics, 15, 5, 631-642   

Elkin, J. (2009). Healthcare Fraud: Detection and Auditing Guide: Travis and Francis Publication: CPA Journal, 78, 11, 125- 148  

Suleiman, R. (2009). The Medium and Evidence-Based Practice: Elsevier Publication: Journal on Issues for Mental Health Nursing, 29, 3, 319-327