Reference no: EM131168670
Assignment 1: LASA - Corporate Compliance
You are a corporate compliance officer for a hospital. You are also a feature writer for The Medical Reporter, an online health magazine. The editor asks you to write an 8-10 page feature story about the steps you should take when fraud and abuse cases are reported to a facility. This is very timely as you recently received a call on your "hotline" regarding a potential fraud and abuse issue. The caller indicated that Dr. Greedy was billing for services that had not been provided. You are in danger of losing reimbursement for Medicare and Medicaid programs if this behavior is not stopped. Your feature should address the ethical and moral components that healthcare providers and healthcare facilities face with fraud and abuse issues. Your research should include the following aspects:
How to conduct an investigation. It should include the following elements:
Reviewing the initial complaint: What are the items you should look for in a compliant to determine validity?
Notifying the appropriate upper management of the complaint unless they are implicated in the complaint: What are the steps to take to determine who is involved?
Obtaining additional information as necessary and developing a plan for the investigation: What other items are important to the investigation?
Conducting interviews with staff, residents and/or management: Delineate the types of questions to ask in the interview.
Determining if the allegations are substantiated or unsubstantiated: Identify criteria to determine if substantiated or unsubstantiated.
How to develop a correction action plan. The plan may suggest:
A recommendation for a subsequent audit or follow-up to the complaint and determination of when this is necessary.
A recommendation to refund any overpayments to federal government, insurance company or individual payer and when that may be the best course of action.
Draw the dependency graph
: Show that the constraint set is not 3-consistent, and show that a branching algorithm that follows the ordering 1,2,3,4 may be required to backtrack.
|
Discuss the mclean hospital study
: Discuss the McLean hospital study. In the study conducted at McLean hospital, how did teen brains compare to adult brains (i.e., describe the differences)
|
Relationship between social class and cultural consumption
: What are the main arguments that Grazian and other readings assigned for this week make about the relationship between social class and cultural consumption
|
Evaluate the impact that a companys code of conduct can have
: Evaluate the impact that a company's code of conduct can have on promoting positive employee behavior, improved decision making, or the willingness to report unethical behavior of coworkers.
|
How to develop a correction action plan
: Conducting interviews with staff, residents and/or management: Delineate the types of questions to ask in the interview. Determining if the allegations are substantiated or unsubstantiated: Identify criteria to determine if substantiated or unsubst..
|
What is the duality gap
: Solve the inference dual of (3.9) using this family of proofs. - Exhibit the proof that solves the dual. What is the duality gap?
|
What is your opinion about behavioral learning theory
: Can using behavioral learning theory help introduce math and science concepts to elementary students and how? Can behavioral learning theory help with classroom management? What is your opinion about behavioral learning theory
|
How much is the total manufacturing cost per unit
: Cinder Company had the following department information for the month: Total materials costs $ 80,000, Equivalent units of materials 10,000. How much is the total manufacturing cost per unit?
|
Analyze measures of emotional and behavioral functioning
: repare a 3-slide Microsoft PowerPoint presentation in which you analyze measures of emotional and behavioral functioning
|