Healthcare: Health Insurance and Fraud E. Ethical

Fraud, Waste and Abuse in the Medicare strategy A Proactive Approach blood line Project Outline Team A The Prairie State Bulls Julie GIldemeister Elena Hallars Teresa OBrien Latia Phelps Laura Wimberley HSM 546 health damages and Managed disquiet Vernice Johnson-Warren Keller Graduate School of job Management March 17, 2013 Synopsis We offer to discuss the problem of humbug, dissipation and horror in Medicare and Medicaid from the viewpoint of a get on with of directors of a community healthcare system.We moderate that a proactive course of action, speckle initially more expensive, will import in a far repair outcome for the system, its providers, and its patients. It will lead to erupt relations non only with the organization but also with our commercial MCO plans. This sales outlet will be addressed on several fronts legislative loopholes, weaknesses in electronic technology, ethical lapses on the part of providers, and enforcement failures. I. decision maker Su mmary A. Environment B. Rules and regulations of Medicare and Medicaid C. healthcare Reform commandment D. worrys with Fraud E. Ethical Considerations of Fraud II. Problem Statement A. Fraud, lavishness and abuse in the Medicare and Medicaid system B. Legislative loopholes C. Weaknesses in electronic medical records D. Ethical lapses in providers E. frequent errors in billing and coding F. Enforcement failures III. belles-lettres Review A. Course text B. Fraud, waste and abuse of Medicare/Medicaid funds C. IT and EMR issues D. Ethical discipline of providers E. Enforcement failures IV. Problem Analysis A.Identification of opportunities for joke in a healthcare system B. Enforcement of Medicare/Medicaid claims report regulations C. Counteracting or preventing a climate of fraud waste and abuse V. Solutions and Implementation A. Streamlining enforcement efforts B. fasten IT loopholes C. Creating provider incentives for responsible behavior in coding and billing D. Pattern ch eck over and claims review to catch trends indicative of fraud, waste or abuse VI. Justification A. terms of fraud, waste and abuse, especially in Medicare claims reclamation processesB. Cost of failure to comply with rules and regulations C. amelioration in facility/provider/payer relations D. Improvement in bullion flow and claims payment E. Improvement in patient and community relations VII. windup VIII. References Aldhizer III, G. R. (2009). Medicare and Medicaid Fraud and Errors A Ticking age Bomb That Must be Defused. diary Of Government Financial Management, 58(4), 12-20. Boerner, C. M. (2010). 60 proceeding Story on Medicare Fraud. journal Of health caution Compliance, 12(1), 29-65. Dietz, D. K. , & Snyder, H. 2007). Internal control differences betwixt community health centers that did or did not experience fraud. Research In Healthcare Financial Management, 11(1), 91-102. Evans, R. D. , & Porche, D. A. (2005). The nature and frequency of medicare/medicaid fraud a nd neutralization techniques among speech, occupational, and physical therapists. Deviant Behavior, 26(3), 253-270. inside10. 1080/01639620590915167. Hambleton, M. (2011). Los Angeles Health Care Fraud saloon Summit Moving from a illness to Wellness Model of Compliance. diary Of Health Care Compliance,13(1), 19-24. Hoppel, A. M. (2012). Career Code Red. (Cover story). Clinician Reviews, 22(10), 1-8. Kongstvedt, P. R. (2007). Essentials of Managed Health Care (5th ed). Sudbury, MA Jones & Bartlett. Moses, R. E. , & Jones, D. (2011). Physician Assistants in Health Care Fraud Vicarious Liability. Journal Of Health Care Compliance, 13(2), 51-75. Robin, D. W. , & Gershwin, R. J. (2010). RAC AttackMedicare recuperation Audit Contractors What Geriatricians Need to Know. Journal Of The American Geriatrics Society, 58(8), 1576-1578. oi10. 1111/j. 1532-5415. 2010. 02974. x Sparrow, M. K. (2008). Fraud in the U. S. Health-Care System Exposing the Vulnerabilities of Automated Payments System s. Social Research, 75(4), 1151-1180. Steinhoff, J. C. (2008). forensic AUDITING A Window to Identifying and Combating Fraud, Waste and Abuse. Journal Of Government Financial Management, 57(2), 10-15. Thorpe, N. , Deslich, S. , Sikula, S. , & Coustasse, A. (2012). Combating Medicare Fraud A Struggling Work In Progress. Franklin job & Law Journal, 2012(4), 95-107.