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.
Expert Solution Preview
Introduction: Fraud and abuse are critical issues in healthcare, often leading to lawsuits and loss of trust between patients and healthcare providers. In this discussion, we will explore the ethical implications of these issues and provide supporting examples.
Fraud and abuse are unethical practices in the healthcare industry that may result in severe consequences for healthcare providers and patients. While fraud involves intentionally submitting incorrect billing or other false statements to obtain money from insurance or government healthcare programs, abuse refers to the excessive use or misuse of resources or service which is not medically necessary. Unfortunately, such practices are common in the healthcare industry, resulting in severe consequences for both providers and patients.
A case in the United States v. Rogelio V. Perea, MD, et al., 2016, exemplifies fraud in the healthcare industry. The case involved a fraudulent billing scheme, where the defendants billed Medicare for services that were not provided or not medically necessary. Dr. Perea, the lead defendant, pleaded guilty to the offense and paid a $4 million fine. The case demonstrates how fraudulent billing abuses government healthcare programs and potentially harms patients by billing them for services they did not receive or do not need.
Opposing Viewpoint: Some argue that healthcare providers must resort to fraudulent and improper billing schemes to stay in business since healthcare is getting more expensive each year. However, healthcare providers must always abide by ethical standards when seeking to obtain payments for rendered medical services. Otherwise, they risk damaging the public faith in the healthcare system, forfeiting their practice license, and serving prison time.
Conclusion: In conclusion, healthcare providers must prioritize ethical considerations over personal interests to avoid fraudulent and abusive practices in the healthcare industry. The case of Dr. Perea indicates that the legal system is not lenient about healthcare violations, and healthcare providers intending to participate in fraudulent billing may face severe legal consequences. Hence, healthcare providers should adhere to the legal and ethical standards set in the healthcare industry, ensuring patients receive optimal and accessible healthcare services irrespective of their financial status.