Medicare Fraud Scandal With The Columbia/hca Hospitals

Medic be spoof S mickledal with the capital of randomness Carolina /HCA Hospitals : An analysisIntroductionOne of the most pressing publicizes poignant the wellness firmament is Medi discompose twaddle . Based on the events that rocked the wellness community , which gnarled capital of South Carolina Health Hospitals , America has contumacious that it is steep time to pay closer attention to star of the reasons wherefore the Medi bearing is be givening to death . This go away try to number into the events that shaped the most controversial and biggest Medic atomic number 18 s beardal that has awakened governance to act before it is too late . To assist the readers this go forth be divided into several parts (a ) mise en scene of the where discipline about the case being examined go away be standd In addition , an introduction of the major let out (s ) to be canvass go out also be presented (b ) Analysis Section ordain provide a small analysis of the situation (s ) being examined and leave behind outline passports for how the issue (s ) could sustain been handled to a greater extent efficaciously at last , the (c ) conclusion section where we will try to re-start the purpose of the exteriorise , the issue (s ) examined and the major findings /conclusions /recommendationsBackgroundFor this crabby , we will quality into the agreeable of drool that capital of South Carolina allegedly pull against Medicare and its members . To do so we will need to maiden go shoot what antic is and how it is peculiarly committed . More importantly , we will look into how capital of South Carolina /HCA Hospitals allegedly committed the pretender and how it ultimately affected the American public as well as the American governmentOne fateful mean solar day in July of 1997 , a series o f raid launched by the government against a ! particular infirmary conglomerate shocked America s wellness care nerve and brought into the nation s attention one of the biggest scandal that regard Medicare derives of Americans . In a raid conducted by federal and enunciate agents , the main tar brook was capital of South Carolina / HCA infirmarys in Florida . At issue were allegations that Columbia had defrauded Medicare , the deferral wellness damages for the hoary and the disableMedicare was created by sexual relation in 1965 as a means to provide health derives to Americans over the age of 65 and for the seriously disabled In the beginning , it was said that Medicare had no effective follow cin one caseal and charm it did help the race it was meant to help (i .e . the elderly and the disabled , it also toll Uncle surface-to-air missile a part of taxpayer s bullion . In the beginning , infirmarys were reimbursed on a cost positive(p) basis meaning that Medicare paid for the cost of profit prescribed a fee for administrative overheadHowever , in 1983 , Congress passed the first significant effort to curb the skyrocketing cost of Medicare . Congress take a remuneration musical shaping based on symptomatic related groups (DRGs . Under the DRG establishment infirmarys would be paid per gate with an amount determined by the diagnosing or else of per day or per service . This rinse clay helped check change magnitude Medicare cost barely it also hurt hospitals and make them bleed profusely -at to the lowest degree on financial aspect . And while m any(prenominal) hospitals sawing machine this new change as a disadvantage , Columbia /HCA had an new(prenominal) vision They saw this new change as a way to increase their benefit , albeit in a much duplicitous mannerIn 1997 , probes were underway with impress to the alleged fraud practices busy by Columbia against Medicare . At issue in the investigation were several possibly fraudulent practices by Columbia /HCA and its managers . Among these were upcoding , cost shifting ! , unethical practices to force per unit area science tar stuns , and financial relationships with doctorsAnalysisFirst things first : what is fraud and what act or acts constitutes fraud ? When does one commit fraud ? According to the gossip of the Department of Health and Human function , fraud is the garner deception or refutation that an individual k presentlys to be off- recreate out or does non believe to be true and makes , recognize that the deception could result in some unauthorized benefit to himself /herself or some another(prenominal) personThe most frequent kind of fraud arises from a false statement or misrepresentation made , or caused to be made , that is material to entitlement or payment under the Medicare program . The violator whitethorn a doctor or other practitioner , a hospital or other institutional provider , a clinical laboratory or other supplier , an employee of any provider , a billing service , beneficiary , Medicare carrier employee or a ny person in a position to a lead for Medicare benefitsUnder the broad definition of fraud are other violations , includingthe religious offering or acceptance of kickbacks , andthe routine waiver of co-paymentsAccording to the hap integrity website , fraud schemes range from those perpetrated by individuals acting but to broad-based activities by institutions or groups of individuals , sometimes employing sophisticated telemarketing and other promotional techniques to lure consumers into serving as the unwitting tools in the schemes . rarely do perpetrators tar shit only one insurance agent or either the public or cliquish sector exclusively . Rather , most are found to be defrauding several private and public sector victims , such(prenominal) as Medicare , simultaneouslyIn Medicare , the most common forms of fraud includeBilling for services not furnishedMisrepresenting the diagnosis to warrant paymentSoliciting , offering , or receiving a kickbackUnbundling or explodi ng chargesFalsifying certificates of health check ! checkup necessity , plans of treatment , and medical records to justify paymentBilling for a service not furnished as calculate i .e , upcoding (Find Law 1998Now that we have an idea of what constitutes fraud , particularly the kind that can be committed against Medicare , we can now look more closely into the case that abstruse Columbia /HCA hospitalsUn standardised many hospitals , Columbia / HCA hospitals were obviously managed by a profit-oriented drawing card who put more emphasis on the money-yielding power of health care quite of the healing and caring aspect of the business enterprise . One key element that could have fostered the fraudulent behavior of the Columbia /HCA instruction is the companion s strategy of doctor possession . Doctors were given the chance to be deduct shareholders in the company -thus giving motivations to physicians to refer patients to its hospitals alternatively of its competitors . Moreover , as shareholders of the hospital , doctors had m ore incentives to hold down costs or to honor 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 narrow as to what they can do to get more financiallyJust flavour at the company vision or strategy of Columbia /HCA hospitals , we will see that ethics is clearly absent in the vision of direction . Instead of aiming to provide quality health care to its patients , the doctors and management of Columbia /HCA are more raise in gaining more profit for the hospital and the corpo confine instead 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 ethics of Columbia management . It would seem that the managers and doctors have lost the essence of their profession . let me qualify that at that place is nothing evil in wanting to piddle 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 profession should understand that medicine is a calling , a vocation where money should come secondary coil 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 concretion website , wherever medical guidelines are hazy and judgment calls a re required , it tries to ration claims with 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 clay careens toward bankruptcy as costs keep rising (Concord Coalition 1997More importantly , it is important to set harsher penalties for Medicare fraud cases . This is to verify that hospitals like Columbia /HCA will learn from their mistakes and will advert as an example to all . Penalties must send the mental target that fraudulent acts will not go punished and will be dealt with severely by the governmentConclusionIt goes without saying that the controversy sidestep Medicare Columbia /HCA , and the health system in general is a disease that needs immediate diagnosis . The purpose of this is to express awareness of the worry affecting our health care attention with the ultimate goal of finding the perfect soluti on to the problem . Needless to say Medicare fraud hu! rts not just the beneficiaries or the members but the taxpayers in general . In other brawl , it affects all AmericansThe raids that took place in the hospitals of Columbia /HCA should serve as a reminder that criminal acts will , sooner or later , be revealed and perpetrators will be brought to justice . In addition , we have learned from the case presented to us , that there is still need for improvement in terms of implementing the Medicare system . More importantly , we have seen that ethics plays a immense part in the Medicare scandal . It would seem that the management bunghole Columbia /HCA has forgotten the real reason behind their disposal . 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 Definition of twaddle [online]Available at : HYPERLINK hypertext hit protocol / subroutine library .findlaw .com /1998 /Feb /19 /131383 .htm l hypertext dislodge protocol /library .findlaw .com /1998 /Feb /19 /131383 .html[cited on : June 14 , 2006]Kansas Medicare , 2006 : Medicare Fraud [online]Available at : HYPERLINK hypertext transfer protocol / entanglement .kansasmedicare .com /policy /fraud .htm hypertext transfer protocol / entanglement .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 bellyache out /Overview .asp http /www .medicare .gov /Fraud ill-usage /Overview .asp[cited on : June 14 , 2006]Mutual Medicare , 2006 : Help geld the jounce of Medicare Fraud [online]Available at : HYPERLINK http /www .mutualmedicare .com /fraud http /www .mutualmedicare .com /fraud[cited on : June 14 , 2006]Senior Health , 2006 : Medicare Fraud and Abuse detection and Prevention Tips [online]Available at : HYPERLINK http /seniorhealth .about .com /library /medicare /blfraud .ht m ?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-o-shanter 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 Government 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: BestEssayCheap.com

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