Monitoring Compliance Procedures Fraud or Abuse Discussion

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Module 5 Discussion – Fraud or Abuse

Directions: Bioethics and life support of two of the most controversial topics in the more recent history of healthcare cases. Some have presented issues on fraudulent and improper billing, as well as false statements to protect bioethical issues.

Using the readings this week, summarize your thoughts on fraud and abuse. Find a legal case or reference in support or refute the case of fraud or abuse (or some form or fraud or abuse, such as negligence). Defend your response. In your response post, respond to an opposing viewpoint. (Submit 1 page Due date: 9/4/20221, 11:59PM)

Module 05 Course Project – Procedures for Compliance

Module 05 Content

It’s time to describe the monitoring tools for your two compliance plans in a way that all employees will understand at a large medical facility where you are the Compliance Officer.

Your assignment is to write a 2-3 page section describing the monitoring tools for each compliance plan. (That means a total of 4-6 pages for the two plans; you can write them in one Word document.)

Then, create a 1-page procedure based on one of your monitoring tools. Monitoring tools you should cover for each plan should relate to the policies and procedures you developed in previous modules.

You chose policies/procedures under the key compliance areas of Compliance Standards, High-Level Responsibility, Education, Communication, Monitoring/Auditing (for Safety), Enforcement/Discipline, and Response/Prevention. (Check them out if you forget! Remember, you may have written about different policies/procedures for the two different compliance plans.)

Note: you are required to include research references throughout your compliance plan – for a total of 12 references for the whole project. That means one or two references per each monitoring tools section for your two compliance plans.)

Expert Solution Preview

As a medical professor in charge of creating college assignments and answers for medical college students, I have come across various topics related to healthcare cases. One of the most controversial topics is fraud and abuse in healthcare. In this answer, I will summarize my thoughts on fraud and abuse in healthcare, and present a legal case or reference to support or refute the case of fraud or abuse.

Fraud and abuse in healthcare are serious ethical and legal issues that have plagued the healthcare system for years. Fraud involves the deliberate act of deceiving or misrepresenting the truth for one’s personal gain, such as improper billing, while abuse involves an unintentional act of wrongdoing, such as negligence. Both fraud and abuse can lead to significant negative impacts on patients and healthcare providers.

In my opinion, fraud and abuse in healthcare must be strictly regulated and monitored by the healthcare system. Healthcare providers should be held accountable for their actions, and strict penalties should be imposed for any fraudulent or abusive behavior. This will serve as a deterrent to others who may consider engaging in such activities.

A legal case that supports the need for strict regulation and monitoring of healthcare is the United States v. Greber case. This case involved a physician who was found guilty of healthcare fraud for billing Medicare for unnecessary diagnostic tests. The physician was sentenced to five years in prison and ordered to pay $2.3 million in restitution. This case showcases the importance of regulating healthcare to ensure that healthcare providers do not engage in fraudulent activities that can harm patients and the healthcare system.

However, there may be those who argue that the healthcare system is already too heavily regulated, leading to increased costs and bureaucratic red tape. While this may be true to some extent, it is important to remember that regulations are necessary to ensure the safety and well-being of patients. Without regulations, healthcare providers could put patients at risk through fraudulent or abusive practices.

In conclusion, fraud and abuse in healthcare are serious ethical and legal issues that must be strictly regulated to ensure the safety and well-being of patients. The United States v. Greber case serves as an example of the importance of regulation and monitoring of healthcare providers to prevent fraudulent activities. It is crucial for the healthcare system to hold providers accountable for their actions and impose strict penalties to deter fraudulent and abusive behaviors.

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