Medicaud Case Study

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Recommended: A medical ethics dilemma

1. Is this an ethical dilemma, a legal problem, or both?

I believe Deborah is facing both an ethical and legal dilemma. According to the National Conference of State Legislatures (NCSL) (2016), “Medicaid fraud involves knowingly misrepresenting the truth to obtain unauthorized benefit”, while abuse is any practice that is inconsistent with the acceptable practice and unnecessarily increases cost. Deborah’s clinic is engaging in Medicaid fraud by creating a fake diagnosis (misrepresenting the truth) in order to receive payment. This is also an ethical dilemma for Deborah because it goes against her belief system by requiring her to lie and commit fraud. Medicaid fraud and abuse uses funding that could be used for appropriate health care services, while also inflating the cost of Medicaid while failing to add value (NCSL, 2016). Deborah needs to decide if keeping her job is worth jeopardizing her …show more content…

According to Bennett, Jr. (n.d.), the federal government is aggressively prosecuting those involved with health care fraud due to the large amount of money at stake. If Deborah decides to provide patient care at this clinic, there is a good chance she will lose her license if the clinic is prosecuted. Even is Deborah decided not to personally commit the fraud, it would be difficult to prove her innocence in the court of law (Butts & Rich, 2013, p. 383). If she chose not to fabricate patient diagnoses, she would still be held responsible for reporting the known fraudulent activity. According to Bennett, Jr. (n.d.), “the punishment for a conviction under the False Claims Act is up to five years imprisonment and a fine of $250,000.00 for an individual” for a felony conviction. If the felony conviction is for a corporation, the penalty is $500,000 (Bennett, Jr., n.d.). If it is a misdemeanor, than the individual fine is $100,000, or $200,000 for a

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