Discussion: Fraud and Abuse in Healthcare

Question Description

Fraud is rampant in the healthcare industry. The size, scope, and complexity of the healthcare industry can attract individuals and organizations intending to defraud third-party payers, government agencies, and individuals. This fraud is perpetrated by those looking to access the billions of dollars available for legitimate medical care to patients needing services at all levels. By fraudulently billing for services that were not provided, kicking back monies to individuals, and carrying out other dishonest and unethical practices, individuals have stolen taxpayer funds and potentially prevented people in need from receiving necessary care. This multi-billion-dollar fraud has come under increasingly intense investigation, enforcement, and prosecution by a multitude of federal, state, and local agencies. Through their activities, billions are being recovered. According to the U.S. Department of Justice, more than $2.5 billion was collected in settlements and judgments from cases involving fraud and false claims in the healthcare industry during 2016. For the seventh consecutive year, healthcare fraud recoveries exceeded $2 billion.

Healthcare leaders must be familiar with the agencies, regulations, statutes, and practice codes that impact the delivery of healthcare. Today’s healthcare leaders must understand the importance of establishing proactive compliance processes and be able to recognize and address potential situations at risk for fraud and abuse.

Discussion: Fraud and Abuse in Healthcare

BY DAY 7 OF WEEK 2

This week, assigned Presenters should post a PowerPoint presentation with a detailed notes section that contains the following:

Incorporation and analysis of the Learning Resources from this 2-week unit, including identification of any apparent gaps in the literature
An original research topic related to the week’s literature (the proposed research topic can be related to the general topic for the week or to gaps in the literature for the week, or it can be related to a specific reading for the week)
Background information on the research topic, including identification of principal schools of thought, tendencies in the academic literature, or commonalities that define the academic scholarship regarding your topic
Evaluation of the main concepts with a focus on their application to business/management practice and their impact on positive social change
A minimum of 10 peer-reviewed, scholarly new references

Note: The presentation must be in APA format and must incorporate direct evidence of addressing the Learning Objectives from this 2-week unit. Each of the content slides must include detailed notes/paragraphs with appropriate citation of peer-reviewed, scholarly references.

list of resources:

Pozgar, G. D. (2016). Legal and ethical issues for health professionals (4th ed.). Burlington, MA: Jones & Bartlett Learning.

Chapter 2, “Contemporary Ethical Dilemmas” (pp. 66–120)

Chapter 13, “Patient Abuse” (pp. 417–436)

Allen, L. P. (2013). Fighting Medicare fraud under the False Claims Act. Health Law Litigation, 10(2), 2¬–6. Retrieved from http://www.americanbar.org/publications/litigation…
Note: You will access this article from the Walden Library databases.

Beimers, T., Disenhaus, J., Kanner, S., Smith, C., Trilling, H., Wisor, R., Andonova, E., Furlow, A., & Thiess, D. (2017). OIG finalizes wide-ranging amendments to civil monetary penalties regulations and Anti-Kickback Statute safe harbors. Journal of Health Care Compliance, 19(1), 9–52. Retrieved from https://lrus.wolterskluwer.com/store/products/jour…
Note: This article is 8 non-consecutive pages in length. You will access this article from the Walden Library databases.

Holland, R. (2014). Of discounts and dangers: Swapping, discounting, and the Anti-Kickback Statute. Journal of Health Care Compliance, 16(1), 37–40. Retrieved from https://lrus.wolterskluwer.com/store/products/jour…
Note: You will access this article from the Walden Library databases.

Mathews, C. (2015). The hospital readmission reduction program: Fraud and abuse concerns. DePaul Journal of Health Care Law, 17(1), 31–46. Retrieved from http://via.library.depaul.edu/jhcl/
Note: You will access this article from the Walden Library databases.

Pham, G. (2015). 2014 healthcare False Claims Act developments. Health Law Litigation, 12(2), 5–9. Retrieved from http://www.americanbar.org/publications/litigation…
Note: You will access this article from the Walden Library databases.

Sidhu, A. S. (2015). The growing threat of qui tam litigation against healthcare providers. Health Law Litigation, 12(1), 12–19. Retrieved from http://www.americanbar.org/publications/litigation…
Note: You will access this article from the Walden Library databases.

Discussion: Fraud and Abuse in Healthcare

Westling, C. R., Walsh, T., & Nelson, W. A. (2017). Perceived ethics dilemmas among Pioneer accountable care organizations. Journal of Healthcare Management 62(1), 18–27. Retrieved from https://www.ache.org/pubs/jhm/jhm_index.cfm
Note: You will access this article from the Walden Library databases.

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[Presentation Title Goes Here] [Your Name Here] Walden University [Heading Goes Here] • Go to the Home tab at the top and click the New Slide or Layout button to access different formatting for your slides. • Choose formatting that presents your information in the most logical way. • Use consistent, grammatically parallel format for bulleted lists (for example, on this slide, each element begins with an imperative verb). [Heading Goes Here] • Keep font of text consistent. • Be sure headings are consistent in their spacing, placement, size, etc. • Consider using the slide after the title slide to summarize your presentation’s points (like an abstract for a paper). [Heading Goes Here] Your slides can also contain entire paragraphs, like this one does. Citation rules apply to presentations just as they do to papers—when using or referencing another author’s ideas, you must cite that source. When incorporating a citation in a slide, do so just as you would in a traditional paper (Smith, 2010). According to Jones (2007), presentations aren’t very different from papers! [Heading Goes Here] Use APA style rules to format any tables and figures in your presentation: Figure 1. Bar graph showing useful information. From “Utilizing bar graphs,” by A. Jones, 2011, Journal of Handy Graphs, 76(2), p. 3. Reprinted with permission. [Heading Goes Here] • Remember to adhere to any assignment guidelines regarding presentation format. This template contains suggestions only. • Keep in mind that there is no such thing as an “APA standard PowerPoint.” Review http://blog.apastyle.org/apastyle/2010/09/dearprofessor.html for more information! References Always include a reference list at the end of your presentation, just like you would in a paper. Reference list entries take the same format they would in a paper: Jones, P. (2004). This great book. New York, NY: Publisher. Smith, W., & Cat, D. (2010). How to make a good presentation great. Presentations Quarterly, 45(4), 56-59. doi:10.123.45/abc Presentation Format During one set of paired weeks in this course, you will be appointed as a Presenter. When you are the Presenter, you will prepare an individual academic presentation, much like a poster session. Your presentation should include an analysis and synthesis of prior research, and your presentation begins the interaction with your colleagues. You will prepare a PowerPoint presentation of 7–10 slides to demonstrate your understanding of the research. Outline for Presentations The following PowerPoint presentation outline is suggested: Slide Number Slide 1 Slides 2–3 Slides 4–6 Slides 7–8 Slides 9–10 Contents of Slide should include: Title Slide—Weeks X–X/Week Title/Presenter Name

An incorporation and analysis of the Required Resources from this pair of weeks, including identification of an original research topic (related to the general topic for the week, to a specific reading for the week, or to apparent gaps in the literature) An identification of principal schools of thought, tendencies in the academic literature, or commonalities that define the academic scholarship regarding your topic An evaluation of the main concepts with a focus on their application to business/management practice and their impact on positive social change APA-formatted References slide(s) (to include a minimum of 10 peer-reviewed, scholarly new references) Guidelines for Presentations You must use APA formatting throughout your presentation and incorporate direct evidence of addressing the Learning Objectives from this 2-week unit. Each of the content slides must include detailed notes/paragraphs in the Notes section with appropriate citation of peer-reviewed, scholarly references. Please refer to the Presentation Rubric for specific grading elements and criteria. Note: If you choose to include graphics of any kind in your presentation, be prepared to accommodate participants with vision loss. Know that you may have to provide a written description of graphic or pictorial material for a fellow student who is visually impaired. o It is the responsibility of any participant with a disability that limits access to the PowerPoint presentations to contact the Instructor and/or Disability Services to make a specific request regarding this assignment. © 2016 Laureate Education, Inc. Page 1 of 1 …
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