How To Address Healthcare Fraud In Your Agency Essay

Length: 2 pages Sources: 2 Subject: Healthcare Type: Essay Paper: #87950427 Related Topics: Ethics In Healthcare, Patient Privacy, Medicare And Medicaid, Obamacare

Excerpt from Essay :

Miscoding on the Billing Forms Discussion Board The fundamental basis for auditing Medicare and Medicaid billing is that the services provided are confidential, patient privacy must be protected, and the written word of the provider is the record of service provision upon which a review must be initiated (Harris, 2007). 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, 2007)

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. And I would explain that these duties obligate employees to comply with reasonable directions from their employers during an internal investigation. The employee should be party to a conversation that an internal investigation may or may not commence based on the information provided, however, not providing information and cooperating with my word as a practice manager will not alter the course of the next steps that will be taken.

Since every healthcare...


-- has a Compliance Program and a Compliance Officer according to the DHHS OIG published in 1998, the matter will be discussed with the Compliance Office (Murphy & Vandenberg, 2003). The physician will be reminded of the conflict of interest (COI) document that she ostensibly signed, and there is an expectation that she has conducted her practice according to that COI and in compliance with the required billing stipulations for Medicare and Medicaid (Murphy & Vandenberg, 2003. Assuming an investigation will be conducted, the main priority at the beginning is to review the match between the numbers of tests or procedures, the costs permitted, and the resultant revenues generated by the provision of care (Harris, 2007). During the investigation, I would review the policies and procedures of the DOC RU.S. with the employee, and also to ensure that any perceived violations are established in policy and procedures guidelines (Murphy & Vandenberg, 2003. The perception is that the offense has been on-going, and I would need to document this in a clear audit trail (Murphy & Vandenberg, 2003. All of the pertinent information will need to be written and summarized in a report that will be given to the appropriate authorities (Murphy & Vandenberg, 2003. The investigation will…

Sources Used in Documents:

References 2

Harris, D. (2007). Contemporary issues in healthcare law and ethics (3rd ed.). Chicago: AUPHA/HAP

Murphy, A.P. And Vandenberg, Q.H. (2003). How to conduct a fraud investigation. Retrieved from

U.S. Department of Health and Human Services and U.S. Department of Justice. Stop Medicare fraud. Retrieved from

UP FOR DISCUSSION NOW: Can you think of a reason why Dr. Jones might over rule his wife (Yikes!!) if she tells him not to buy the machine (which is the conclusion of the sample solution, and what 1/4 of you determined in your own papers)? What might be some of the benefits of having the machine, even with it losing money? (Think about all the DaVinci robots being bought now by competing hospitals...)

Cite this Document:

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