Organizational Responsibility and Current Healthcare Issues (healthcare Fraud and abuse)

Organizational Responsibility and Current Healthcare Issues (healthcare abuse and fraud)

Introduction

Health care fraud is a major issue that has attracted the attention of physicians, hospitals, patients, insurers, policy makers, government agencies, and academics. It is a single element citizen's hope never surface in their organizations. It can create a culture of mistrust and fear, leading to assumptions and questions, with the capability to severely destroy or cripple an organization's financial solvency and reputation (Denyer .C, 2007). People believe fraud would never occur in their organization. Health care fraud is a broad phrase encompassing a spectrum of activities in which money that is intended to pay for health care services is in some way diverted to private use. Fraud is a legal term that refers to actions taken with the intent to deceive, such as intentional misrepresentation of information that insurers and government programs rely on in making payment decisions. A physician who intentionally submits a bill for services that were never performed, for example, deceives the payer into making an improper payment (Hannigan N.S., 2006).

Fraudulent health care activities also are actionable at the state level. Many state laws mirror the Anti-Kickback and Stark statutes, some pertain only to Medicaid fraud, while others apply broadly to all health care payers(Morgan Lewis ,2010). Moreover, the DRA offered incentives for U.S to endorse their own Medicaid false claim supplies. State attorneys general have become adept at using consumer fraud statutes to pursue health-related activities, particularly in the pharmaceutical context. This essay examines the current situation of the health care abuse and fraud and how organizational governance and structure the cultural responsibilities of an organization while focusing on social responsibility affecting health care fraud and abuse. This essay will also review the recommendations for culture or structure changes necessary to prevent this situation with the allocations and resources to prevent this situation in the future.

Discussion

Health care fraud News

A health care fraud was charged in outpatient psychiatric clinic for mentally ill senior citizens in a short income urban area, for this purpose an investigator was ordered. Several psychiatrists were charging money for every service individually which was opposed by the Medicare contract who directed to charge one daily rates. One third of the claims which was submit to the Medicare were up coded .The psychiatrist only arrive at the clinic and simply were asking the nurses how the patients were doing and were charting psychotherapy notes. They were also charging fee of $ 100 for the patients who were suppose to easily be treated by existing clinical services, and those patients were not demonstrating any mental condition. The news is filled with majority stories such as the hypothetical story mention above (World Health Organization, 2011).

A doctor was sentenced to 24 months imprisonment, in USA, who was ordered to disburse $727000 in refund for payment in cash, where the medical doctor put signature on empty certificates and prescription for medicines, mainly for the individual patient he never ...