Fraud In Health Care
Assessment
The most interesting part in Gupta’s article is in her conclusion. The author notes that fraud in the health sector is a reality and should be exposed. Gupta further states that clinical operations are vulnerable to fraud because the system lacks effective mechanisms to detect, investigate, and prosecute individuals or groups of people who engage in fraud. Finally, the author calls on everyone in the health sector to develop a culture of research, which should be based on fundamentals of openness, integrity, and honesty. Consequently, the medical research council definition of both Fraud and misconduct has often been used in several research papers in regards to Fraud and misconduct. According to the medical research council, fraud and misconduct arise as a result of plagiarism of medical findings, falsification of medical results and a fabrication of the medical findings.
Furthermore, it may entail failures to maintain all the properly established medical practice protocols that may result into grave risk to humans. The MRC definition of fraud and misconduct may also entail the unauthorized usage or damage to the all or some of the research material and apparatus from research done by another individual in the medical field. Although some problems may arise in the medical practice …show more content…
due to errors in practice and implementation, the MRC does not identify such as fraud and misconduct. Furthermore, the MRC does not include all forms of poorly done medical research that was not well intended by rather results of the research design.
Statistical evidence
A 2012 report on fraud and misconduct reported that typical organizations lost up to 5 percent of their revenues in fraud and misconduct annually.
If compared to the gross projected figures of 2011, the figure translates to around 3.5 trillion dollars. According to the research, the median losses resulting from each occupational fraud case alone amounted to around $140,000 which accounts for one fifth of all the cases that the $1 million fraud related cases in 2011.The study also showed that misappropriation of assets was the most reported form of fraud accounting for a median of around $120000 loses according to the results of the individuals that were surveyed in the
study.
Furthermore, clinical fraud and misconduct related to financial misstatement amounted to around $1 million of all the cases that were reported amounting to a median of around $250000 of all the cases that were reported in the survey. The study also discovered that those perpetrators with holding higher authority and positions in a given organization caused more losses related to fraud and misconduct (ACF, 2012. The data showed that these caused around $573000 losses in the fraud in only 2011.Lower level managers and practitioners caused around $18000 losses in the medical industry. On the other side, losses to medical fraud and misconduct perpetrated by other employees amounted to a median of $60,000 from the individuals that were surveyed in the study.
Recommendations
Gupta urges leaders in the health sector to be more vigilant in order to prevent cases of fraud and misconduct in the system. Leaders should raise concerns or warning signals when they suspect any misbehavior rather than keeping quite. Failure to address cases of fraud or misconduct makes the behavior prevalent, which might in later become uncontrollable (Gosfield, 2005). Leaders, if possible, should report cases to the necessary bodies so that effective measures and actions are taken to curb or address the issue (Mercola, 2005). Employers in the health sector should also consider recruiting employees who do not have any records of misconduct (Michael, 2003). Leaders in the health sector can liaise with the security department to access every employee’s records. The records could help in gaining information on one’s conduct. The information can be useful in selecting good and well-mannered employees. Several studied have shown that the presence of the anti-fraud detection systems in the organizations for instance the hospitals had a correlation with a reduction of such cases in the medical industry.
Conclusion
Participation in fraud lowers the quality of service provision in the health sector. Leaders should not shy away from addressing the problem since such vices (fraud and misconduct) might have adverse effects on service delivery. People in leadership positions should initiate researches that seek to detect, investigate, and prosecute individuals who engage in fraudulent acts. The fraudulent acts include extorting money from patients who are willing to pay for better services. The issue should be addressed with the urgency it deserves to prevent further harm to inferior individuals and to improve service delivery in clinical operations.
The most interesting part in Gupta’s article is in her conclusion. The author notes that fraud in the health sector is a reality and should be exposed. Gupta further states that clinical operations are vulnerable to fraud because the system lacks effective mechanisms to detect, investigate, and prosecute individuals or groups of people who engage in fraud. Finally, the author calls on everyone in the health sector to develop a culture of research, which should be based on fundamentals of openness, integrity, and honesty. Consequently, the medical research council definition of both Fraud and misconduct has often been used in several research papers in regards to Fraud and misconduct. According to the medical research council, fraud and misconduct arise as a result of plagiarism of medical findings, falsification of medical results and a fabrication of the medical findings.
Furthermore, it may entail failures to maintain all the properly established medical practice protocols that may result into grave risk to humans. The MRC definition of fraud and misconduct may also entail the unauthorized usage or damage to the all or some of the research material and apparatus from research done by another individual in the medical field. Although some problems may arise in the medical practice …show more content…
due to errors in practice and implementation, the MRC does not identify such as fraud and misconduct. Furthermore, the MRC does not include all forms of poorly done medical research that was not well intended by rather results of the research design.
Statistical evidence
A 2012 report on fraud and misconduct reported that typical organizations lost up to 5 percent of their revenues in fraud and misconduct annually.
If compared to the gross projected figures of 2011, the figure translates to around 3.5 trillion dollars. According to the research, the median losses resulting from each occupational fraud case alone amounted to around $140,000 which accounts for one fifth of all the cases that the $1 million fraud related cases in 2011.The study also showed that misappropriation of assets was the most reported form of fraud accounting for a median of around $120000 loses according to the results of the individuals that were surveyed in the
study.
Furthermore, clinical fraud and misconduct related to financial misstatement amounted to around $1 million of all the cases that were reported amounting to a median of around $250000 of all the cases that were reported in the survey. The study also discovered that those perpetrators with holding higher authority and positions in a given organization caused more losses related to fraud and misconduct (ACF, 2012. The data showed that these caused around $573000 losses in the fraud in only 2011.Lower level managers and practitioners caused around $18000 losses in the medical industry. On the other side, losses to medical fraud and misconduct perpetrated by other employees amounted to a median of $60,000 from the individuals that were surveyed in the study.
Recommendations
Gupta urges leaders in the health sector to be more vigilant in order to prevent cases of fraud and misconduct in the system. Leaders should raise concerns or warning signals when they suspect any misbehavior rather than keeping quite. Failure to address cases of fraud or misconduct makes the behavior prevalent, which might in later become uncontrollable (Gosfield, 2005). Leaders, if possible, should report cases to the necessary bodies so that effective measures and actions are taken to curb or address the issue (Mercola, 2005). Employers in the health sector should also consider recruiting employees who do not have any records of misconduct (Michael, 2003). Leaders in the health sector can liaise with the security department to access every employee’s records. The records could help in gaining information on one’s conduct. The information can be useful in selecting good and well-mannered employees. Several studied have shown that the presence of the anti-fraud detection systems in the organizations for instance the hospitals had a correlation with a reduction of such cases in the medical industry.
Conclusion
Participation in fraud lowers the quality of service provision in the health sector. Leaders should not shy away from addressing the problem since such vices (fraud and misconduct) might have adverse effects on service delivery. People in leadership positions should initiate researches that seek to detect, investigate, and prosecute individuals who engage in fraudulent acts. The fraudulent acts include extorting money from patients who are willing to pay for better services. The issue should be addressed with the urgency it deserves to prevent further harm to inferior individuals and to improve service delivery in clinical operations.