Organizational Responsibility
Organizational Responsibility and Current Health Care Issues
HCS 545
Organizational Responsibility
The success or downfall of an organization rests on the organizational structure and culture influence. In order for an organization to be successful, there are several incidents that they must work to prevent, such as health care fraud and abuse. This paper will review fraud and abuse and how organizational structure and governance, culture, and focus on the social responsibility affect or influence the described situation. This paper will also overlook resources and allocation to prevent situations n the future and the ethical issues that may relate to the determination of the described solution. Furthermore, this paper will work to provide recommendations for changes surrounding structure or culture for an organization in order to prevent situations from happening in the future.
Health Care Fraud While reading the local newspaper recently, I came across a story about an outpatient psychiatric clinic for the mentally ill senior citizens that was charged with health care fraud, and that an investigation had been ordered. The clinic, which is located in a low-income urban area, was charged with health care fraud after several of the clinics psychiatrists were caught arriving to the clinic, asking the nurse on duty how the patients were doing and then would base psychotherapy notes on the nurses feedback and then charge Medicare for 50 minutes of sessions. The investigation showed that one third of the claims that were submitted to Medicare were up coded and the clinic was billing each of those “services” individually as opposed to charging one daily rate, which is directed by the Medicare contract. Through the investigation, other inappropriate charges were brought to the surface, such as referrals by local family physicians for a fee of $100 for patients who did not have a mental conditions but had a condition that could have been treated by the
HCS 545
Organizational Responsibility
The success or downfall of an organization rests on the organizational structure and culture influence. In order for an organization to be successful, there are several incidents that they must work to prevent, such as health care fraud and abuse. This paper will review fraud and abuse and how organizational structure and governance, culture, and focus on the social responsibility affect or influence the described situation. This paper will also overlook resources and allocation to prevent situations n the future and the ethical issues that may relate to the determination of the described solution. Furthermore, this paper will work to provide recommendations for changes surrounding structure or culture for an organization in order to prevent situations from happening in the future.
Health Care Fraud While reading the local newspaper recently, I came across a story about an outpatient psychiatric clinic for the mentally ill senior citizens that was charged with health care fraud, and that an investigation had been ordered. The clinic, which is located in a low-income urban area, was charged with health care fraud after several of the clinics psychiatrists were caught arriving to the clinic, asking the nurse on duty how the patients were doing and then would base psychotherapy notes on the nurses feedback and then charge Medicare for 50 minutes of sessions. The investigation showed that one third of the claims that were submitted to Medicare were up coded and the clinic was billing each of those “services” individually as opposed to charging one daily rate, which is directed by the Medicare contract. Through the investigation, other inappropriate charges were brought to the surface, such as referrals by local family physicians for a fee of $100 for patients who did not have a mental conditions but had a condition that could have been treated by the
References: Boan, D., Funderburk, F. (2003). Healthcare quality improvement and organizational culture. Retrieved October 3, 2012, http://www.delmarvafoundation.org/newsAndPublications/reports/documents/Organizational_Culture.pdf Mastin, Y.M. (2000). Journal of Law and Health: The punishment of “health care fraud.” Retrieved October 5, 2012, http://www.highbeam.com/doc/1G1-85016554.html Mayer, C.M. (1995) Preventing fraud and abuse fallout – healthcare industry includes related article. Retrieved October 3, 2012, http://findarticles.com/p/articles/mi_m3257/is_n4_v49/ai_17000470/pg_2/?tag=mantle_skin;content Ritchie, M. (2000). Organizational culture: an examination of its effect on the internalization process and member performance. Retrieved October 3, 2012, http://www.allbusiness.com/management/988816-1.html