Preview

Dicussion Board Assignment

Satisfactory Essays
Open Document
Open Document
441 Words
Grammar
Grammar
Plagiarism
Plagiarism
Writing
Writing
Score
Score
Dicussion Board Assignment
Chapter 16 Questions
1. A physician and his colleagues decide to set up a laboratory owned by a dummy corporation in their wives' names and begin to refer patients to this laboratory. What (if any) laws have they violated?

Whilst referring their very own patients to a laboratory, the physician and his colleagues violated the False Claims Act (FCA) and the Physician Self-Referral Law because they formulating a dummy corporation in a means of deceiving its patients and the government.

Confronted with rising costs, the Federal government is fomenting a quiet revolution in how doctors and hospitals are paid and regulated. At the forefront of this revolution are two trends, one punitive, and one incentive based, which will require healthcare providers to rethink the way they do business. Over the last ten years, the Federal government has dramatically increased its enforcement activities, both criminal and civil, in an effort to essentially force healthcare providers to improve the quality of care they provide. "Compliance," in contrast, refers to a separate category of risk involving reimbursement and billing issues. In its role as the largest healthcare payor in the nation, the Federal government has traditionally taken the lead in investigating and prosecuting healthcare providers who illegally obtain payment from the various federally funded healthcare programs. The purpose of the compliance function, as described by the Federal government, is to insure that facilities are in compliance with the various billing and reimbursement requirements intended to prevent such fraudulent billing (Schindler, 2009).

Schindler, D. S. (2009). Pay for Performance, Quality of Care and the Revitalization of The False Claims Act. Health Matrix: Journal Of Law-Medicine, 19(2), 387-422.

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

In light of the new

You May Also Find These Documents Helpful

  • Better Essays

    Week 2 Hcs Case Study

    • 1023 Words
    • 3 Pages

    Jerry is faced with an ethical dilemma on whether or not to call in a prescription for Valium. Ethically, the answer is not. Jerry, in this scenario, is working as an office assistant and even though he has both trainings as a medical assistant and an LPN, he is not authorized to refill a prescription. Even if Jerry were working as an LPN for the day he does not have the authorization from Dr. Williams to make that call. In doing so, Jerry could lose his licensure.…

    • 1023 Words
    • 3 Pages
    Better Essays
  • Satisfactory Essays

    On 2/21/17, anonymous reporting party (RP) reported that resident Roma McAffe (DOB and age unknown) did not have her Percocent for 3 days. RP did not have the exact date of the incident. RP stated that the med techs are not allowed to write in the MAR that a resident's medication is not available. The med techs are to write that the resident refused the medication. Resident in room 127 was out of a medication, Senna. It was documented that the resident refused it because he did not have constipation. RP stated that "The leaders of the pack, Greg and Jerry" are instructing them to write refused because the facility was cited and they do not want to be cited again. RP expresses that they cannot document "falsehood" and at the same time, they…

    • 192 Words
    • 1 Page
    Satisfactory Essays
  • Powerful Essays

    This Special Fraud Alert addresses compensation paid by laboratories to referring physicians and physician group practices (collectively, physicians) for blood specimen collection, processing, and packaging, and for submitting patient data to a registry or database. OIG has issued a number of guidance documents and advisory opinions addressing the general subject of remuneration offered and paid by laboratories to referring physicians, including the 1994 Special Fraud Alert on Arrangements for the Provision of Clinical Laboratory Services, the OIG Compliance Program Guidance for Clinical Laboratories, and Advisory Opinion 05-08. In these and other documents, we have repeatedly emphasized that providing free or below-market goods or services to a physician who is a source of referrals, or paying such a physician more than fair market value for his or her services, could constitute illegal remuneration under the anti-kickback statute. This Special Fraud Alert supplements these prior guidance documents and advisory opinions and describes two specific trends OIG has identified involving transfers of value from laboratories to physicians that we believe present a substantial risk of fraud and abuse under the anti-kickback statute. Westhill Healthcare Insurance…

    • 2780 Words
    • 9 Pages
    Powerful Essays
  • Good Essays

    The Court had to decide whether Business and Professional Code § 2056 can be applied to a disagreement between two physicians regarding how to medically treat a patient, or if § 2056 only applies to disputes between physicians and third party or healthcare payors. Business and Professional Code § 2056 provides protection against retaliation for physicians who advocate for medically appropriate healthcare for their patients.…

    • 1548 Words
    • 6 Pages
    Good Essays
  • Good Essays

    The Case of the Tuskegee Syphilis Research Study is one of the most gruesome historical cases I’ve read in a long time. For individuals to be screened and monitored under false pretenses while carrying a sexual transmitted disease is beyond unethical and illegal for my taste. This put everyone at risk, especially those already infected without knowledge.…

    • 340 Words
    • 2 Pages
    Good Essays
  • Satisfactory Essays

    Dr Mccall Paper

    • 530 Words
    • 3 Pages

    Read the case study in Ch. 4 of Medical Law and Ethics that begins, “Jerry McCall is Dr. William’s office assistant.”…

    • 530 Words
    • 3 Pages
    Satisfactory Essays
  • Good Essays

    difffrence

    • 2773 Words
    • 12 Pages

    Hapless Hospital is concerned about fulfilling its obligations under JCAHO to adequately evaluate applicants for Medical Staff Privileges. Dr. Goody, a board certified surgeon, was appointed by the hospital's credentials committee to be a proctor for (observe) a surgeon who had applied for staff privileges. In accordance with the hospital bylaws, Dr. Goody was asked to observe ten (10) surgeries performed by the applicant and then submit a written report to the credentials committee. The patient in one of those surgeries sued the surgeon and Dr. Goody claiming that the surgeon committed malpractice and Dr. Goody failed to intervene.…

    • 2773 Words
    • 12 Pages
    Good Essays
  • Better Essays

    Joint venture practices, on the other hand, (either by their design or because of it) are under continuous scrutiny for just such practices. Joint venture practices are structured to provide ancillary services, a business structure much different than sharing ancillary help (as with traditional group practices). Under this structure, treating physicians set up their own 'in-house ' diagnostic and pathological laboratories and various types of treatment centers to provide patients with prescribed therapies. These joint venture practices are structured to provide patients with a virtual one stop doctor 's visit, no referrals needed, and, all services are rendered 'in-house '. Arguably, under this arrangement, the spirit of the AMA code of ethics against profiteering from patient treatment is completely desecrated, as the checks and balances of peer oversight has been removed. Still, legally, these kinds of practices are permitted, under Stark Law (Omnibus Budget Reconcilliation Act of 1989, 1989) because of the 'in-house ' structure of the businesses.…

    • 1286 Words
    • 6 Pages
    Better Essays
  • Good Essays

    Stark Law

    • 604 Words
    • 2 Pages

    Stark Law was put in place to prevent physicians or groups from taking advantage of self- referrals. "It is a federal statute whose purpose is to, in essence, limit conflicts of interest in situations where physicians have financial relationships that could cause them to steer referrals for patients to certain providers or potentially over utilize services based on their financial relationships,"(Sandrick 2008). For this paper I will analyze if the two physicians violated Stark Law by their actions.…

    • 604 Words
    • 2 Pages
    Good Essays
  • Good Essays

    * Health care is a vast ever-changing demand in the United States. Because of that high demand, quality has been a concern for many patients. Each day patients put their health and trust in the hands of health care providers. Unfortunately, there have been times when the treatment provided, whether accidental or intentional, has caused harm to the patient. Patients who have experienced injury have the right to file a civil complaint against that provider that caused the injury. Some possible reasons for civil complaints are that personal information for a patient was shared without proper consent, negligence, or assault. These injuries are covered under Tort Law. This essay will identify a civil complaint process that patients may follow in the event of misconduct or incompetence by a provider. The role of the regulatory agencies to investigate the allegations of the misconduct will be discussed along with how they apply disciplinary actions if warranted. Potential criminal liabilities, risk management strategies, quality assurance programs to reduce the risk of liability and the process to follow in the event that charges are filed against a provider will all be identified.…

    • 896 Words
    • 4 Pages
    Good Essays
  • Good Essays

    Summary: Paying For Care

    • 390 Words
    • 2 Pages

    An interesting aspect of the entire environment regarding how providers are compensated is provided by the RAND Corporation. The article highlights the transformation and the models that have been structured within the health care industry, the article is appropriately titled: Paying for Care: In Depth.…

    • 390 Words
    • 2 Pages
    Good Essays
  • Good Essays

    False Claims Act Essay

    • 430 Words
    • 2 Pages

    If the physician knowingly document treatment and procedures that he or she know that they did not perform to receive a large reimbursement, this is a violation. A physician’s office is held to the same standards are an organization. However, a hospital can violate the False Claims Act by not reporting or returning overpayments that may have been received. When I worked in a hospital, at the end of the year a report was created to be submitted to Center of Medicaid and Medicare for annual cost. An organization can violate the False Claims Act by not reporting any…

    • 430 Words
    • 2 Pages
    Good Essays
  • Better Essays

    Medical identity theft is when someone steals your personal information (like your name, social security number, or Medicare number) to obtain medical care, buy drugs, or submit fake billings to Medicare in your name. This definition alone is enough to explain how the safety of a patient can be affected if their medical identity is stolen. Having the name and/ or social security number is enough to even go further than just affecting patient safety; it can impact their everyday life outside of the medical field. If a person has the name, social security number, and the medical number basically gives that person…

    • 2080 Words
    • 9 Pages
    Better Essays
  • Powerful Essays

    Civil complaints can arise when a patient feels as if they have been mistreated according to the “standard of care”. Some patients have legitimate cases, yet there are other people who are looking for a possible lawsuit. This paper will explore the process for filing a civil complaint against a physician. This paper will discuss what patients and consumers will use in the event of suspected misconduct or possible incompetence. It will also explore the roles of the respective regulatory agencies in investigating allegations and determining and applying any appropriate disciplinary actions. It will also identify any potential criminal liability that might result to the health care professional relative to abuses perpetrated in practices involving procedures, as well as professional misconduct, and explore the events the follow in the event that criminal charges are filed for the described criminal behavior.…

    • 1397 Words
    • 6 Pages
    Powerful Essays
  • Powerful Essays

    Over the past several years, the public has become increasingly aware of physicians and providers supplementing their incomes with financial incentives from pharmaceutical companies and medical device manufacturers (Thomas et al., 2014). These incentives include financial compensation, extravagant meals, and educational conferences in exotic locations with all expenses paid. Meanwhile, the cost of health care to consumers continues to soar, disproportionately in the United States compared to other industrialized nations. Most of the public would conclude that such gifts reflect a conflict…

    • 4466 Words
    • 18 Pages
    Powerful Essays