One of the biggest contributors to health care costs that I have seen during my time in the healthcare industry is insurance fraud. One example of such fraud came about two months ago. I was taking a phone call from a provider that was upset that one of their claims had denied even though all of their previous claims had been paid. In researching with a partner plan it was determined that the claim denied because this medical provid...
The OHD even admitted that reporting physicians may have fabricated their versions of the circumstances surrounding the prescriptions written for patients. "For that matter, the entire account could have been a cock-and-bull story. We assume, however, that physicians wer...
patient history is neglected resulting to a serious health crisis or ever death and lawsuits.
In the past, the health care industry experienced many changes and challenges. For accepting accountability the health care professional believes they may be obligated to justify their actions and clarify the validation that provoked the actions and the consequences of their actions. However, all medical professionals assume the responsibility for their behavior and must deal with the outcome of their actions. The manager of the long-term manager has collected valuable information and created a pamphlet to demonstrate the importance of accountability and liability outcomes in health care organizations. The pamphlet will also discuss the standard of care and possible any liabilities, the rights of providers and their duties in the delivery of care, analyze what rights do the patient have at the levels of the state and federal regarding statutory and regulatory laws. The pamphlet will also identify the different types of health care fraud; the penalties that associated with these illegal activities. Nevertheless, it will also explain in detail the legal and ethical effects it has on the use of technology.
However, there are certain issues that may result from unfilled gaps between the expected and the actual provided health care treatment, and these issues vary in severity. But unfortunately, there are many people as patients who may not be fully aware of their legal right to file clinical negligence claims that could have been valid and successful.
Finally, the last issue that was revealed in this case study, was the issue with the older director of the assisted living facility was disciplined for not following procedures and processes when admitting new patients. The other issue that she was disciplined for was an alleged termination of an employee without having another witness present during the termination process. Based on this accounting the director refuted these claims and was terminated for not calling in every day as instructed while on an approved medical leave of absence (Walsh, 2013). As the case study unfolded it also revealed that there were other additional issues that were added to the termination reasoning that was from other administrators who had worked with the
Reviewing the case study on Twin Oaks Hospital the first problem identified was David Hardy the director of personnel knew of the lingering problems and did not address them earlier. Due to his lack of ethics or possibly inexperience, by not having a policy ad procedure manual updated could potentially place the hospital in jeopardy of violating state and federal laws enforced by Equal Employee Opportunity Commission Civil Rights Act of 1964 and Equal Pay Act on behalf of employees. (Lewis)
In the case of United States ex rel. Geraldine Petrowskivs. vs Epic System Corporation, Geraldine Petrowski worked as a the Supervisor of Physician’s Coding at WakeMed Health from 2008 until 2015. She was then trained to be a charge capture analyst for Epic’s billing charge capture system. After that she went on to work as a hospital liasion for the implemention of Epic at WakeMed Health. In 2015 Petrowski alleged that a glitch in Epic’s billing system had caused hundreds of millions of dollars in overbilling. Soon after, Petrowski filed a lawsuit with Florida’s U.S district. In the complaint Petrowski wrote “ Epic’s billing software defaults to charging for both the applicable base units for anesthesia provided on a procedure, as well as
In the summer of 2003, Gary Shephard learned that he needed to have surgery on his left knee. In accordance with the requirements of his insurance plan, Mr. Shephard obtained prior approval for the surgery from Blue Cross/Blue Shield and made plans to have the surgery on or about August 5, 2003. On August 1, 2003, a few days before his scheduled surgery, Mr. Shephard was laid off due to lack of work. (Shephard v. O'Quinn Case No. 3:05-CV-79, 2013) Defendant John O'Quinn, Gary Shephard’s boss, told him that the layoff would be temporary and that his insurance coverage was paid for one month after his layoff. Therefore, Mr. O'Quinn assured Mr. Shephard that his health insurance would still be effective the following week when he had knee surgery.
This article includes recently released information about an incident that has been completely settled. The article states that a nurse practitioner, Martha C. Smith-Lightfoot, took a spreadsheet from University of Rochester Medical Center (URMC) that contained around the information of around 3,000 patients. She had previously worked at URMC, but she had switched jobs to work at Greater Rochester Neurology. When she left URMC, she took the spreadsheet with her without their URMC’s consent.
"Tenet Healthcare Corporation, through its subsidiaries, owns and operates acute care hospitals and related health care services" (Tenet, 2007) "On September 27, 2006, Tenet Healthcare Corporation signed an annual update of its ongoing corporate integrity agreement (CIA) with the Office of Inspector General (OIG)" (Jones, 2007, p. 7). Tenet, as are many other healthcare organizations, is faced with “inadequate medical record documentation; poorly executed patient informed consent; inadequate patient education; poor physician-patient communication; lack of medical necessity for performed medical services; and improper performance of medical services” (Jones, 2007, p. 8).
Healthcare fraud and abuse has changed significantly over the past few years. Through the introduction of many modern technologies, national healthcare systems like Medicaid have been able to work much more efficiently; however, many problems come with the up-and-coming technology, and more innovative solutions are required. First, according to The Department of Health and Human Services and The Department of Justice Healthcare Fraud and Abuse Control Program on page 9 of their 2014 report, the Healthcare Fraud Prevention Partnership (HFPP), a partnership with public and private sectors to fight fraud, had increased its participants to 37 public, private and state partner organizations. The number significantly increased to 70, compared to
Answer. Dave short violated Compliance standards and procedures to be followed by the employees must be developed. Although legal compliance is critical, of equal importance are dealings with clients and associates. For example, standards should emphasize the importance of forthright advertising and full disclosure, the requirement for honest assessments of patient conditions and needs, and the imperative of treating both residents and associates with dignity and respect (Singh, 2015). Even though, Mr. Short thought that the employees are been treated with the high respect he failed to make them feel respected. In addition, if the company