Discuss the differences between fraud and abuse

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Assignment: Read chapter 16 of your text. Answer the Discussion Questions on pages 551-552 (questions 1-11) in essay format.

Use a minimum of 2 scholarly sources, listed in APA format. See attached tutorial on APA format.

1. Discuss the differences between fraud and abuse. During your discussion, provide examples of each and how health care managers might deal with them.

2. How has the history of health care compliance changed since its inception? (Hint: Look at the ways in which penalties have increased in various ways.) W hat do you think will be the key to getting control of the issue of fraud and abuse in the future?

3. Choose one of the recent laws that have been enacted that are included in the chapter and discuss why it is or isn't an effective stop-gap to health care fraud and abuse.

4. E MT AL A is a far-reaching act; explain several of its benefits and describe how it is effective at preventing fraud and abuse as opposed to detecting it.

5. Describe your responsibilities as a health care manager as they apply to fraud and abuse. W hat if you were a unit manager? A department manager? A member of the executive division?

6. As you try to understand the fact that tens of billions of dollars are lost to fraud, is it the number that is troublesome or the fact that nobody can agree on an estimate? W hat is being done and can be done to reduce fraud and prevent it?

7. You are the new compliance manager for a health care organization. Describe the steps you will take to ensure that your compliance plan is legal and effective.

8. A physician and his colleague decide to set up a laboratory owned by a dummy corporation in their wives' names and begin to refer patients to this laboratory. W hat (if any) laws have they violated?

9. A psychiatrist bills for 10 hours of psychotherapy and medication checks for a deceased woman. H as he committed fraud or abuse? Can the deceased woman's estate press charges if the bills were sent to Medicare, and not to the family?

10. An attorney sees a plastic surgeon and is so happy with her face-lift that she begins to refer all her friends and family. At her 6-month follow-up, she says, "So, Doc, I've sent you all these patients, where's my 30% cut of your fees?" W hat should the plastic surgeon do?

11. While working on your homework for this course and surfing the Internet to check out all the fascinating links, you realize the person who manages the branch of the new durable medical equipment company (D ME xcellence) where you work looks just like someone on the O IG Most Wanted list. H e even has the same first name! And he has a wife who looks like the woman on the list with him! While you really need this new job to help pay your way through school, you have a sinking feeling all is not good at DM Excellence.

Reference no: EM132331309

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