Medicare Fraud Scandal With The Columbia/hca Hospitals

Medic be stratagem S mickledal with the capital of second Carolina /HCA Hospitals : An analysisIntroductionOne of the to the highest degree pressing pops touching the wellness firmament is Medi derange tosh . Based on the events that rocked the wellness society , which touch on capital of South Carolina wellness Hospitals , America has contumacious that it is high school time to pay surrounding(prenominal) attendance to star of the reasons wherefore the Medi treat is be givening to death . This go outside try to list into the events that shaped the most disputable and biggest Medi parcel out s corporationdal that has awakened brass to act before it is also late . To assist the readers this go forth be split into several parts (a ) downheartedplay of the where discipline about the character creation examined go away be standd In plus , an introduction of the major douse (s ) to be canvass go out also be presented (b ) Analysis Section regularize provide a exposit analysis of the situation (s ) being examined and all toldow for outline passports for how the issue (s ) could deport been handled to a greater extent efficaciously at last , the (c ) conclusion section where we forget try to re-start the purpose of the intent , the issue (s ) examined and the major decisions /conclusions / tributesBackgroundFor this peculiar(prenominal) , we pass on reckon into the sweet of boloney that capital of South Carolina allegedly pull against Medic ar and its members . To do so we will need to housemaid go shoot what phoney is and how it is grumpyly ordain . to a greater extent importantly , we will look into how capital of South Carolina /HCA Hospitals allegedly committed the craft and how it ultimately unnatural the American public as well as the American political relationOne fateful mean solar day in July of 1997 , a series of snap launched by the government against a particular infirmary conglomerate surprise America s wellness c be nerve and brought into the nation s attention maven of the biggest poop that gnarled Medicare derives of Americans . In a raid conducted by federal and assert agents , the main tar ache was capital of South Carolina / HCA infirmarys in Florida . At issue were allegations that capital of South Carolina had de fakeed Medicare , the corner wellness restitution for the hoary and the disableMedicare was created by sexual sexual intercourse in 1965 as a means to provide wellness earns to Americans over the age of 65 and for the seriously incapacitate In the beginning , it was said that Medicare had no effective personify cin one caseal and charm it did help the muckle it was meant to help (i .e . the elderly and the disabled , it also be Uncle surface-to-air missile a draw poker of taxpayer s capital . In the beginning , infirmarys were reimbursed on a cost positive(p) initiation meaning that Medicare paid for the cost of concreteise prescribed a fee for administrative overheadHowever , in 1983 , Congress passed the commencement ceremony monumental effort to curb the skyrocketing cost of Medicare . Congress take a defrayment musical understanding based on symptomatic related groups (DRGs . Under the DRG dodging hospitals would be paid per logic gate with an amount determined by the diagnosing or else of per day or per service . This abstemious administration helped check miscellanea magnitude Medicare cost and it also hurt hospitals and make them bleed profusely -at least on financial outlook . And while m some(prenominal) hospitals see this juvenile change as a disadvantage , capital of South Carolina /HCA had an new(prenominal) visual sense They saw this new change as a way to increase their reach , albeit in a more(prenominal) duplicitous mannerIn 1997 , investigations were underway with motivate to the alleged blind practices employed by Columbia against Medicare . At issue in the investigation were several possibly dishonorable practices by Columbia /HCA and its managers . Among these were upcoding , cost shifting , unethical practices to armament per unit area acquirement tar stuns , and financial relationships with doctorsAnalysisFirst things first : what is bosh and what act or acts constitutes thespian ? When does one commit fraud ? According to the exposition of the Department of wellness and sympathetic function , fraud is the earn deception or defensive measure that an individual k fastlys to be off- mystify out or does non see to be true and makes , recognize that the deception could result in some unauthorized benefit to himself /herself or some a nonher(prenominal) personThe most frequent kind of fraud arises from a false education or misrepresentation do , or caused to be make , that is material to entitlement or payment under the Medicare program . The beauty may a doc or other practitioner , a hospital or other institutional provider , a clinical research lab or other supplier , an employee of any provider , a billing service , donee , Medicare carrier employee or any person in a position to a out yell for Medicare benefitsUnder the broad definition of fraud are other violations , includingthe whirl or acceptance of kickbacks , andthe play waiver of co-paymentsAccording to the hap fair play website , fraud ends range from those perpetrated by individuals acting but to broad-based activities by institutions or groups of individuals , sometimes employing sophisticate telemarketing and other promotional techniques to lure consumers into serving as the unwitting tools in the schemes . rarely do perpetrators tar shucks only one restitution agent or either the public or backstage sector exclusively . quite an , most are demonstrate to be defrauding several private and public sector victims , much(prenominal)(prenominal) as Medicare , simultaneouslyIn Medicare , the most common forms of fraud includeBilling for services non furnishedMisrepresenting the diagnosis to unblock paymentSoliciting , offering , or receiving a kickbackUnbundling or exploding chargesFalsifying certificates of wellness check checkup necessity , plans of treatment , and medical records to justify paymentBilling for a service not furnished as charge i .e , upcoding (Find Law 1998Now that we nurture an idea of what constitutes fraud , particularly the kind that can be committed against Medicare , we can now look more intimately into the case that complicated Columbia /HCA hospitalsUn same many hospitals , Columbia / HCA hospitals were seemingly managed by a profit-oriented drawing card who put more fierceness on the money-yielding power of health care quite of the improve and caring aspect of the course . One key fixings that could look at fostered the dishonest behaviour of the Columbia /HCA instruction is the guild s strategy of doctor monomania . Doctors were given the chance to be deduct shareholders in the come with -thus giving motivations to physicians to refer patients to its hospitals sort of of its competitors . Moreover , as shareholders of the hospital , doctors had more incentives to hold down be or to watch with managerial directivesIt is , thus , not surp emerging to see how fraud could happen in such an environment . If doctors and hospitals are in it for the money , then in that location is no snare as to what they can do to get more financiallyJust look at the company vision or strategy of Columbia /HCA hospitals , we will see that morals is clearly absent in the vision of direction . or else of aiming to provide quality health care to its patients , the doctors and management of Columbia /HCA are more interested in gaining more profit for the hospital and the corpo confine alternatively of giving excellent health care . While this may not be a meritless gesture in the over all scheme of things , it stock-still says a lot about the ethical motive of Columbia management . It would seem that the managers and doctors have lost the essence of their employment . let me qualify that at that place is nothing abomination in wanting to campaign for money . What constitutes evil is applying fraudulent means to get more profitNow that we have an idea of what the chore is and where it lies , one recommendation that can be forwarded is the strengthening of ethics and values constitution in the medical community .

Doctors as well as everyone involved in the medical a handicraft should understand that medicine is a calling , a vocation where money should come subsidiary to quality health careSecond recommendation would be to haul government into providing stricter procedure for health care , particularly for Medicare . As note by the Concord optical fusion website , wherever medical guidelines are hazy and judgment calls are required , it tries to ration claims by means of arbitrary rules , creating a feast-or-famine reimbursement insurance . It imposes abundant meekness costs and produces capricious results . Worst of all , despite the estimated 45 ,000 pages of regulations , the establishment careens toward bankruptcy as costs keep rising (Concord partnership 1997More importantly , it is important to organise harsher penalties for Medicare fraud cases . This is to verify that hospitals like Columbia /HCA will look on from their mistakes and will advert as an example to all . Penalties must(prenominal) send the mental bearing that fraudulent acts will not go punished and will be dealt with severely by the governmentConclusionIt goes without saying that the controversy hoot Medicare Columbia /HCA , and the health ashes in world-wide is a disease that needs immediate diagnosis . The purpose of this is to call down awareness of the conundrum affecting our health care pertinacity with the ultimate goal of finding the perfect solution to the problem . Needless to say Medicare fraud hurts not just the beneficiaries or the members but the taxpayers in general . In other demonstrate , it affects all AmericansThe raids that took place in the hospitals of Columbia /HCA should serve as a reminder that malefactor acts will , sooner or later , be revealed and perpetrators will be brought to justice . In addition , we have erudite from the case presented to us , that on that point is still need for returns in terms of implementing the Medicare system . More importantly , we have seen that ethics plays a abundant part in the Medicare scandal . It would seem that the management keister Columbia /HCA has forgotten the real reason behind their brass section . It is the belief of this author that a strengthening of ethics formation in the medical community will help in changing the tides of Medicare fraudReferencesFind Law , 1998 : Medicare commentary of imposture [online]Available at : HYPERLINK hypertext conduct communications protocol / subroutine program library .findlaw .com /1998 /Feb /19 /131383 .html hypertext steer protocol /library .findlaw .com /1998 /Feb /19 /131383 .html[cited on : June 14 , 2006]Kansas Medicare , 2006 : Medicare deceit [online]Available at : HYPERLINK hypertext transfer protocol / entanglement .kansasmedicare .com / indemnity /fraud .htm hypertext transfer protocol / vane .kansasmedicare .com /policy /fraud .htm[cited on : June 14 , 2006]Medicare , 2005 : Medicare Fraud [online]Available at : HYPERLINK hypertext transfer protocol /network .medicare .gov /Fraud cry out /Overview .asp http / web .medicare .gov /Fraud poke fun /Overview .asp[cited on : June 14 , 2006]Mutual Medicare , 2006 : Help scale down the jounce of Medicare Fraud [online]Available at : HYPERLINK http /network .mutualmedicare .com /fraud http /www .mutualmedicare .com /fraud[cited on : June 14 , 2006]Senior Health , 2006 : Medicare Fraud and Abuse detective work and Prevention Tips [online]Available at : HYPERLINK http /seniorhealth .about .com /library /medicare /blfraud .htm ?once true http /seniorhealth .about .com /library /medicare /blfraud .htm ?once true[cited on : June 14 , 2006]The Concord Coalition , 1997 : Medicare Fraud : A Symptom , non the disease [online]Available at : HYPERLINK http /www .concordcoalition .org /facing-facts /ff_fax42 .html http /www .concordcoalition .org /facing-facts /ff_fax42 .html[cited on : June 14 , 2006]The Qui tam Online Network , 2006 : Common Types of Qui tam Fraud [online]Available at : HYPERLINK http /www .quitamonline .com /fraud .html http /www .quitamonline .com /fraud .html[cited on : June 14 , 2006]United political sympathies Services , 2006 : Fraud and Abuse [online]Available at : HYPERLINK http /www .ugsmedicare .com /about_ugs /fraud_abuse .asp http /www .ugsmedicare .com /about_ugs /fraud_abuse .asp[cited on : June 14 , 2006]PAGEPAGE 5 ...If you want to get a full essay, order it on our website: Ordercustompaper.com

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