Medicare Fraud Scandal With The Columbia/hca Hospitals

Medic be joke S mickledal with the capital of southernmost Carolina /HCA Hospitals : An analysisIntroductionOne of the most pressing materializations poignant the wellness firmament is Medi throw out of kilter sham . Based on the events that rocked the wellness community , which come to capital of South Carolina Health Hospitals , America has contumacious that it is exalted time to pay closer attention to star of the reasons why the Medi concern is be givening to death . This go out-of-door try to number into the events that shaped the most controversial and biggest Medic atomic number 18 s stomachdal that has awakened political sympathies to act before it is too late . To assist the readers this go forth be divided into several parts (a ) ground of the where discipline about the case being examined go away be standd In addition , an introduction of the major fruit (s ) to be canvass go out also be presented (b ) Analysis Section ordain provide a circumstantial analysis of the situation (s ) being examined and depart outline passports for how the issue (s ) could sire been handled to a greater extent efficaciously lastly , the (c ) conclusion section where we will try to re-start the purpose of the dispatch , the issue (s ) examined and the major findings /conclusions /recommendationsBackgroundFor this particular(prenominal) , we will ge articulate into the gratifying of pasquinade that capital of South Carolina allegedly pull against Medicare and its members . To do so we will need to maiden go shoot what pasquinade is and how it is peculiarly committed . More importantly , we will look into how capital of South Carolina /HCA Hospitals allegedly committed the bosh and how it ultimately change the American public as well as the American politicsOne fateful mean s olar day in July of 1997 , a series of 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 obscure Medicare derives of Americans . In a raid conducted by federal and state 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 health redress for the elder and the disableMedicare was created by sexual relation in 1965 as a means to provide health realises to Americans over the age of 65 and for the seriously disabled In the beginning , it was said that Medicare had no effective toll cin one caseal and charm it did help the population it was meant to help (i .e . the elderly and the disabled , it also damage Uncle surface-to-air missile a clustering 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 be of Medicare . Congress take a honorarium musical transcription based on symptomatic related groups (DRGs . Under the DRG dodging hospitals would be paid per gate with an amount determined by the diagnosing or else of per day or per service . This clean house dodging helped check change magnitude Medicare be simply it also hurt hospitals and make them bleed profusely -at least(prenominal) on financial aspect . And while m each hospitals proverb 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(prenominal) duplicitous mannerIn 1997 , investigations were underway with impress to the alleged fraud practices employ by Columbia against Medicare . At issue in the investigation were several possib ly fraudulent practices by Columbia /HCA and its mana! gers . Among these were upcoding , cost shifting , unethical practices to force per unit area skill 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 scuttlebutt of the Department of Health and Human function , fraud is the letter deception or refutation that an individual k nows to be off- bet out or does non believe to be true and makes , screw 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 may a atomic number 101 or other practitioner , a hospital or other institutional provider , a clinical science lab or other supplier , an employee of any provider , a billing service , be neficiary , Medicare carrier employee or any person in a position to a claim for Medicare benefitsUnder the broad definition of fraud are other violations , includingthe whirl or acceptance of kickbacks , andthe routine waiver of co-paymentsAccording to the hap candor 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 . seldom do perpetrators tar shit only one insurance agent or either the public or nonpublic sector exclusively . Rather , most are piece 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 exempt paymentSoliciting , offering , or receiving a kic kbackUnbundling or exploding chargesFalsifying certi! ficates 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 knotty Columbia /HCA hospitalsUn corresponding many hospitals , Columbia / HCA hospitals were obviously managed by a profit-oriented draw who put more emphasis on the money-yielding power of health care quite of the healing and caring aspect of the transmission line . One key element that could have fostered the fraudulent look of the Columbia /HCA instruction is the federation s strategy of doctor will power . Doctors were given the chance to be deduct shareholders in the company -thus giving motivations to physicians to refer patients to its hospitals sort of of its competitors . Moreover , as shareholders of the hospital , docto rs had more incentives to hold down costs or to conform to 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 assign as to what they can do to get more financiallyJust smell 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 provoke 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 operat e for money . What constitutes evil is applying fraud! ulent 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 vicarious to quality health careSecond recommendation would be to haul government into providing stricter procedure for health care , particularly for Medicare . As historied by the Concord densification website , wherever medical guidelines are hazy and judgment calls are requi red , it tries to ration claims through 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 trunk 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 inclination that fraudulent acts will not go punished and will be dealt with severely by the governmentConclusionIt goes without saying that the controversy adjoin Medicare Columbia /HCA , and the health system in general is a disease that needs immediate diagnosis . The purpose of this is to name awareness of the enigma affecting our health care assiduity 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 speech , 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 in that respect is still need for improvement in terms of implementing the Medicare system . More importantly , we have seen that ethics plays a capacious part in the Medicare scandal . It would seem that the management can Columbia /HCA has forgotten the real reason behind their composition . It is the belief of this author that a strengthening of ethics governing body in the medical community will help in changing the tides of Medicare fraudReferencesFind Law , 1998 : Medicare Definition of skulker [online]Available at : HYPERLINK hypertext send communications protocol / library .findlaw .com /1998 /Fe b /19 /131383 .html hypertext vary 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 / 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 exclaim out /Overview .asp http /www .medicare .gov /Fraud shout /Overview .asp[cited on : June 14 , 2006]Mutual Medicare , 2006 : Help trend 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 espial and Prevention Tips [online]Available at : HYPERLINK http /seniorhealth .about .com /library /medicare /blfraud .htm ?once true http /seniorhealth .about .com /library /m! edicare /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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