I need answers of all five questions mentioned in section post by day 4 Question

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I need answers of all five questions mentioned in section post by day 4

Question:Criminal Cases in Health Care

For this Discussion, you examine a criminal case in a health care setting similar to where you work or intend to work (such as a nursing home, hospital, or transitional care facility) and propose ways that a health care administrator can prevent this kind of crime.

To prepare for this Discussion:

Review Chapters 5 and 19 of Legal and Ethical Essentials of Health Care Administration for descriptions of criminal law in health care.

Do online research to find a legal case, journal article, or detailed news article describing a recent criminal case involving the kind of health care facility in which you are interested in working. The case you select may involve fraud and abuse (such as defrauding the Medicare or Medicaid programs, the Stark self-referral law, anti-kickback statute, or price-fixing) or other criminal act (such as patient abuse, murder, or theft).

A good source for cases is the Medicaid Fraud Control Unit. Consider looking through one or two state websites, which can be accessed through this page, http://www.namfcu.net/states, to locate a case.

Identify the laws that are involved in your selected case, and bring to mind the ramifications of this criminal action on the individuals and organizations involved.

Consider possible motivations behind this criminal act. What could an administrator do to prevent this from happening or to address it effectively once it is detected?

Review the description of compliance programs on page 117 of Legal and Ethical Essentials. Would a compliance program be of value in preventing or detecting and then correcting this criminal issue?

By Day 4, post a response to the following:

1. Briefly summarize the case you located, and provide a citation (and URL, if possible) for your source(s).

2. What are the specific legal issues involved? Who is liable?

3. What are the possible consequences to individuals and organizations in a case such as this?

4. Discuss the role of the administrator in preventing criminal acts such as these.

5. Do you think a corporate compliance program would help to address this issue? If so, explain how. If not, explain why you think it wouldn't.

Explanation / Answer

(1)Briefly summarize the case you located, and provide a citation (and URL, if possible) for your source(s).

In December 2009, the Iowa Republican required to distinguish how a Miami psychiatrist was lettering more than 96,000 treatments for Medicaid patients. It was closely double the amount of the second uppermost prescriber in Florida. The psychiatrist, Dr. Fernando Mendez-Villamil, answered with a acerbically expressed communication of his own saying that he never believed he would be criticized for at hard work or for being very prearranged and effective, he inscribed the senator. Usually health-care fraud costs the government and insurance companies about $100 billion a year in overprices and other rip offs. It is a continuous channel on the nation’s prosperity, weakening the aptitude to provide excellence healthcare to those maximum in necessity. The problematic isn’t just the rising positions of criminals in white coats who misuse the US health-care organization for self-enrichment. The problematic part is also that approximately Americans have faith in robbery from the government is no big pact. The investigation revealed high number of patients and doctor was able to attend them all within 15 minutes per day. This would involve around 2-3 prescriptions for quetiapine – a psychiatric drug. These were billed under Medicaid program. He would receive among $63,000 and $67,000 each month and $800,000 a year in revenue just from patient visit fees. When visiting the patients, the investigator would always find the patients giving excuse of not showing proof of not able to show the usage of medication. The investigation revealed that the clinical notes were all the same for all patients and the office seemed to be organized as an assembly line to facilitate billing. The doctor’s medical assessments termed the patients completely disabled mentally and therefore they were eligible to receive Social Security disability payments. In turn the patients would receive benefits from the government and the drug given to them would be sold.

REFERENCE:

RICHEY, W.

An epic case of medical fraud – and the agent who cracked it

In-text: (Richey, 2017)

Your Bibliography: Richey, W. (2017). An epic case of medical fraud – and the agent who cracked it. [online] The Christian Science Monitor. Available at: https://www.csmonitor.com/USA/Society/2017/0621/An-epic-case-of-medical-fraud-and-the-agent-who-cracked-it [Accessed 16 Aug. 2017].

(2) What are the specific legal issues involved? Who is liable?

This case is pure fraud. The people involved in this are highly responsible for this fraudulence. This includes the patients lining up for psychiatric diagnosis and receiving benefits from Medicaid and selling the drugs that they receive which actually a patient who is in reality mentally ill should be receiving even though they are working full time as observed in these search warrant cases. The doctor on the other hand is making money by having just 3 staff and attending huge number of patients making it a money making business rather than serving the patients and illegal use of Medicaid privileges.

(3) What are the possible consequences to individuals and organizations in a case such as this?

After the charges were proved against the doctor, he was removed from the Medicaid program in June 2010 till a period of 3 + years with around 15,000 dollars fine. Usually the doctor is also imprisoned for up to 5 years if there is negligence involved.

(4) Discuss the role of the administrator in preventing criminal acts such as these.

Knowing about the laws like - Medicare and Medicaid Acts, HIPAA, recovery audit contractors, etc. Education and training play a major role, and training from compliance staff play a vital role. Administrators should be aware of these fraudulent activities to report them immediately by raising a red flag.

(5) Do you think a corporate compliance program would help to address this issue? If so, explain how. If not, explain why you think it wouldn't.

To avert an organization from contributing in healthcare deception and abuse actions, providers should comprehend important healthcare fraud regulations, contrivance a compliance package, and recover medical billing and business operations procedures. A robust compliance package would start a ethos within a hospital that endorses preclusion, detection and determination of examples of behavior that do not follow to Federal and State law, and Federal, State and reserved payer healthcare program necessities, as well as the hospital’s principled and business strategies, the HHS Office of the Inspector General also known as OIG stated within official compliance leadership geared near the hospital location.

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