Wait a second!
More handpicked essays just for you.
More handpicked essays just for you.
two pillars of ethical leadership
ideal leadership traits
two pillars of ethical leadership
Don’t take our word for it - see why 10 million students trust us with their essay needs.
Recommended: two pillars of ethical leadership
Many use the term whistleblower as a way to label employees who externally report misconduct or abuse of authority. Whistleblowers do it because they don’t believe their company will manage the matter properly or because they are enraged or unsatisfied after their struggle to report unethical behaviors or abuse of authority is deemed ineffective (ERC, 2012). They’re eventually torn between loyalty to their employer and their moral responsibility to the law.
Description:
The case of chief financial officer Ralph Williams, who soon after his employment for Health Management Associates, uncovered a scheme to defraud The State of Georgia Medicaid Program. Health Management Associates and Dallas-based Tenet Healthcare and their affiliates referred pregnant women living in the country illegally to for-profit hospitals operated by HMA and Tenet in exchange for kickbacks from fraudulent Medicaid claims. The Medicare and Medicaid Patient Protection Act, known as the anti-kickback statute, prohibit paying for or accepting money to arrange for medical treatment under federally funded programs. Williams also alleges that Tenet used a similar scheme in a number of its hospitals. Soon after Williams, voiced his concerns about the fraudulent arrangement to company leaders he was fired without reason. These hospitals paid Clinica kickbacks camouflaged as interpreter service payments to funnel emergency Medicaid patients their way and increase their bottom line (Brumback, 2013/01/08)."
Assess of stakeholders:
Health Management Associates, Tenet Healthcare and their affiliates can be charged in Federal court for violating the anti-kickback statute of Medicaid law. They can also be made to pay substantial fines to the State of Georgia. The S...
... middle of paper ...
...ed my resolution by using the ethics problem-solving model. I utilized a combination of the virtue, principle and results oriented approaches to explain my resolution. It’s the responsibility of the chief financial officer to do what is in the best interest of the greater good. The greater good would be for the chief financial officer to maintain a healthy relationship with his employers and avoid any and all of risks of retaliation, by practicing the art of anonymous activism (Svara, 2007, pg., 121).
References
Brumback, K. (2013/01/08). Whistleblower suit: Hospitals defrauded Medicaid. Usa Today. Retrieved from: http://www.usatoday.com/search/whistleblower/
Ethics resource center. (2012/05/31). Just what is a whistleblower? Retrieved from: http://ethics.org/news/2011nbes-reporting Svara, J. (2007). The ethics primer. Sudbury, MA: Jones and Bartlett Publishing
Anti-Kickback Statute prohibits anyone knowingly or willfully offering, paying or soliciting or receiving remuneration, directly or indirectly; in cash or kind; in exchange for; patient referrals or furnishing or arranging a good or service for a Federal healthcare program including Medicare or Medicaid. Stark would also apply to Hanlester as well but Stark was not enacted until after the Hanlester case. Stark is strict liability, does not require the knowingly/willfully element, and is not prosecuted criminally.
While voluntary, non-compliance with Obamacare’s strategy will cost the state. South Carolina’s share of the nation’s ACA-engineered Med...
Showalter, J. S. (2012). The Law of Healthcare Administration (6th ed.). Chicago, IL: Health Administration Press.
In December 2011, Texas Health and Human Services Commission (HHSC) received federal approval of a Medicaid Section 1115(a) Demonstration Waiver, entitled “Texas Healthcare Transformation and Quality Improvement Program,” for the period starting with December 12, 2011 through September 20, 2016. The main objective of the 1115 Waiver is to improve access to and quality of health care by expanding Medicaid managed care programs and promoting health care delivery system reforms while containing cost growth. Specifically, the Waiver created two new pools of funding—Uncompensated Care (UC) and Delivery System Redesign and Innovation Payment (DSRIP) pools—by redirecting funds that were available under the old Upper Payment Limit (UPL) payment methodology.
On January 30, 2018, the Office of Inspector General’s Office (OIG) received a hotline report alleging Dr. Katrina Alexander committed abuse, fraud, mismanagement and waste against the VA by purposely lying and manipulating scheduling to receive un-deserved overtime pay, misleading providers, clerks and patients about availability in her schedule. Further, the Psychologist doubled billed for groups, misused the billing codes for psychological testing getting her higher Relative Value Units (RVU), possibly overcharging patients, then allowing her to appear as working more than any other provider. The claimant alleges that this is causing significant access issues for the Mental Health Center (MHC). Additionally, leadership at the facility permitted the Psychologist sole control of her schedule (only Mental Health provider in MHC with this permission) that led to her ability to mask the improper activity, and no action taken by the Texas Veterans Health Care System’s leadership to rectify the alleged improper activity.
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...
Jacobson, P. (1999, July/August). Legal challenges to managed care cost containment programs: an intital assessment. Courts & Managed Care, 69-85.
Another downfall to HMO coverage is selective-contracting. This is a process where hospitals deny treatment to patients because their...
Medicare fraud occurs when healthcare providers, suppliers, and private companies charge for services or supplies patients never receive. Additionally, abuse of the Medicare program also occurs because physicians and suppliers do not always follow best medical practices which leads to excessive costs through improper payments, or medically unnecessary services, both of which abuse the program. Conservative estimates suggest he...
The health care system in the United States is one of the most complex forms of healthcare system. What makes the system complex is that there are multiple factors involved. For example, there are multiple players and payers involved in the system. This includes physicians, administrator of health services institutions, insurance companies, large employers and lastly the Government Shi & Singh, 2012). Each of these players and payers are involved to protect their own economic interest. Hospitals for instances, wants to maximize reimbursement from both private and public insurers. Insurance companies and managed care organizations are concerned with how they can maintain their share of the health care insurance market, while physicians seek to maximize their income and have minimal interference with the way they practice medicine (Shi & Singh, 2012). It is obvious that there is no centrality of the health care system. In other words, there is no one department or in particular government body that is unilaterally in charge of the administration of the health care system as it is in the other developed nations where they have a single payer system, which is the government. Instead, the U. S. has health system that is financed by private sectors. According to Shi and Singh,(2012), 54% of total health care expenditures is privately financed through employers , while the remaining 46% is financed by the government. Lack of centrality in monitoring the total expenditures through global budgets or control over the availability and utilization of services coupled with most hospitals and clinics now been privately owned may potential...
Pozgar, G.D. (2012). Legal Aspects of Health Care Administration. United States of America: Jones and Bartlett Learning, LLC.
HealthSouth is A Public company who is providing outpatient rehabilitation services, They noticed that the business is not that great as they proclaimed, business is not so profitable and it also have too much expenses which this will end up taking away from the profit and they will show lower earnings that expected so they came up with a fraudulent idea to create false entries in their books by claiming that the expenses they have is not real expenses, they called it investing like everyone understands when a business is buying a building its not called a expenses which will show the business less profitable ,it is the opposite the business is growing, the same think they did with entering regular expenses like payroll or utility expenses
Healthcare services have been on the rise for over 10 years now. According to a 2012 consumer alert, the industry provided $2.26 trillion in payments for more than four billion health insurance benefit claims in the year 2011(Fraud in Health Care). The bulk of the claims and the mainstream of fraud and abuse stem from the Medicare system professionals, who are knowledgeable about the process and persuade new clients into handing over their pertinent information in hopes of deception and illegitimate claims. Multiple and double billing, fraudulent prescriptions, are some of the major flaws in this organization that has made the healthcare services industry curdle. (AGHAEGBUNA, 2011) This is a non-violet crime and is often committed by very educated people including business people, hospital, doctors, and administrators.
Although Hollate introduced a compliance program and code of conduct when it went public, the programs were put on “the back burner”. This outcome is not surprised for that the company does not pay attention to the programs. It is, therefore, important to “reinforce the values” and “employee a boundary system when actions are inconsistent with the code of conduct” for the purpose of early detection. Tyco provides a good example after its scandal, by initiating “mandatory annual compliance training for all its employees worldwide” and creating the Tyco Guide to Ethical Conduct to familiarize employees with company expectations and help them make ethical decisions. As tips is the most useful method for internal and external sources to detect frauds, the whistleblower hotline should be well communicated with encouragement on reporting any suspicious activity. In addition, to improve the effectiveness of the compliance program and code of conducts, Hollate should implement management monitoring and evaluation on a regular
Whistle blowing is an attempt of an employee or former employee of a company to reveal what he or she believes to be a wrongdoing in or by a company or organization. Whistle blowing tries to make others aware of practices that are considered illegal or immoral. If the wrongdoing is reported to someone in the company it is said to be internal. Internal whistle blowing tends to do less damage to the company. There is also external whistle blowing. This is where the wrongdoing is reported to the media and brought to the attention of the public. This type of whistle blowing tends to affect the company in a negative way because of bad publicity. It is said that whistle blowing is personal if the wrongdoing affects the whistle blower alone (like sexual harassment), and said to be impersonal if the wrongdoing affects other people. Many people whistle blow for two main reasons: morality and revenge.