Dealing with fraud

Introduction1

Discussion1

Healthcare System1

Fraud in the Health Care System2

Evaluate how the Healthcare Qui Tam affects health care organizations2

Qui Tam for Healthcare2

Impact of Healthcare Qui Tam on Health Care Organizations3

Qui Tam And Laws5

Examples of Qui Tam Cases5

Case 17

Case 27

Case 38

Case 48

Admission Procedure in a Health Care Facility Following the Laws for of Medicare and Medicaid Referrals9

Starks Law and the Hospital Admission9

Exceptions in the Starks law10

Admission procedure10

Developing a corporate integrity program for mitigation of incidents of fraud11

Developing A Plan To Protect Patient Information In Accordance With The Laws12

Conclusion13

References14

Dealing with Fraud

Introduction

Dealing with fraud in the health care system has become an essentiality. The fraud is the only factor that has been causing the health care system with the loss of billings of dollars every year. The nurses like the other health care professionals hold the extreme responsibility of dealing with the frauds and securing the rights of the patients as well as the health care organizations. This document explains the fraud in the health care system from the point of view of a chief nursing officer of an obstetric health care facility. The assignment will evaluates how the Healthcare Qui Tam affects health care organizations, provides examples of the existing qui tam cases, devices the procedure for admission into a health care facility that upholds the law about the required number of Medicare and Medicaid referrals, advocates about a corporate integrity program that will mitigate incidents of fraud and assess how the recommendation will impact issues of reproduction and birth and develops a plan that will help t protect patient information.

Discussion

Healthcare System

The health care system refers to the specialized well formed system that incorporates a wide variety of healthcare professionals, institutions and resources, working by following a collaborative approach to provide maximum health and safety to the patients.\

The health care system of United States is subjected to a continuous growth and improvement. Ten years ago, this health care system was declared “broken”, but with the rapid advancements and extensive tireless efforts of the professionals, the United States health care system has shown massive improvements (Garson, 2000). However, there are some problems that still remain evident. These include the lack of coverage of the insured population, inequality in delivery of health care services, and fraud n the health care system.

Fraud in the Health Care System

Fraud in health care system is one of the white collar crimes that have been prevailing in the American health care system from over a decade. As estimates states, the loss of money from the budget designed for the US health care system to fraud has exceeded from m10 percent (Sparrow, 1996), to more than 20 percent at the moment (Berwick, Hackbarth, 2012). In a white paper by Robert Kelly, fraud and abuse have been defined as one of the primary causes of costing the health care system an enormous amount of expenditure gong in waste. As he defines fraud, it is false reimbursement claim made by an institution, organization of personnel, on the heath care system. Kickbacks are also evident problems in the healthcare system, referring to fraud and abuse of the resources. It is the process in which he providers usually prefer the treatments that are not necessary and keeps their personal benefit as the prime focus ...