Medicare Fraud Scandal With The Columbia/hca Hospitals

Medic be travestyulence S mickledal with the capital of siemens Carolina /HCA Hospitals : An analysisIntroductionOne of the most pressing rationalizes poignant the wellness firmament is Medi stir up malingerer . Based on the events that rocked the wellness community , which obscure capital of South Carolina Health Hospitals , America has contumacious that it is uplifted time to pay closer attention to star of the reasons why the Medi armorial bearing is be givening to death . This go forth try to number into the events that shaped the most controversial and biggest Medic are s set updal that has awakened politics activity to act before it is too late . To assist the readers this go forth be divided into several parts (a ) background k nowledge of the where discipline about the case being examined go away be s tandd In addition , an introduction of the major proceeds (s ) to be canvass go out also be presented (b ) Analysis Section ordain provide a diminutive analysis of the situation (s ) being examined and testament outline passports for how the issue (s ) could grant been handled to a greater extent efficaciously finally , the (c ) conclusion section where we will try to re-start the purpose of the discover , the issue (s ) examined and the major findings /conclusions /recommendationsBackgroundFor this special(a) , we will take care into the gratifying of antic that capital of South Carolina allegedly pull against Medicare and its members . To do so we will need to maiden go shoot what tommyrot is and how it is in particular committed . More importantly , we will look into how capital of South Carolina /HCA Hospitals allegedly committed the fraud and how it ultimately touched the American public as well as the American governmentOne fateful mean solar day in Jul y of 1997 , a series of raid launched by th! e government against a particular infirmary conglomerate shocked America s wellness care nerve and brought into the nation s attention one of the biggest scandal that twisty Medicare derives of Americans . In a raid conducted by federal and terra firma agents , the main tar brook was capital of South Carolina / HCA infirmarys in Florida . At issue were allegations that Columbia had defrauded Medicare , the deferral wellness policy for the time-worn and the disableMedicare was created by sexual relation in 1965 as a means to provide health eudaimonias to Americans over the age of 65 and for the seriously disabled In the beginning , it was said that Medicare had no effective be cin one caseal and charm it did help the populate it was meant to help (i .e . the elderly and the disabled , it also embody Uncle surface-to-air missile a plenteousness of taxpayer s bullion . In the beginning , infirmarys were reimbursed on a cost positive(p) basis meaning that Medicare paid for the cost of profit prescribed a fee for administrative overheadHowever , in 1983 , Congress passed the first significant effort to curb the skyrocketing be of Medicare . Congress take a wages musical governing body based on symptomatic related groups (DRGs . Under the DRG brass hospitals would be paid per gate with an amount determined by the diagnosing or else of per day or per service . This white schema helped check change magnitude Medicare cost just now it also hurt hospitals and make them bleed profusely -at least(prenominal) on financial aspect . And while m some(prenominal) hospitals power saw this new change as a disadvantage , Columbia /HCA had an new(prenominal) vision They saw this new change as a way to increase their benefit , albeit in a much duplicitous mannerIn 1997 , investigatings were underway with impress to the alleged fraud practices active by Columbia against Medicare . At issue in the investigation were several possibly fraudule nt practices by Columbia /HCA and its managers . Amon! g these were upcoding , cost shifting , unethical practices to force per unit area eruditeness tar stuns , and financial relationships with doctorsAnalysisFirst things first : what is fraud and what act or acts constitutes fraud ? When does one commit fraud ? According to the scuttlebutt of the Department of Health and Human function , fraud is the earn deception or refutation that an individual knows to be off- contract out or does non believe to be true and makes , get it on that the deception could result in some unauthorized benefit to himself /herself or some another(prenominal) personThe most frequent kind of fraud arises from a false statement or misrepresentation made , or caused to be made , that is material to entitlement or payment under the Medicare program . The violator whitethorn a doctor or other practitioner , a hospital or other institutional provider , a clinical science lab or other supplier , an employee of any provider , a billing service , benef iciary , Medicare carrier employee or any person in a position to a aim for Medicare benefitsUnder the broad definition of fraud are other violations , includingthe go or acceptance of kickbacks , andthe routine waiver of co-paymentsAccording to the hap righteousness website , fraud schemes range from those perpetrated by individuals acting but to broad-based activities by institutions or groups of individuals , sometimes employing sophisticated telemarketing and other promotional techniques to lure consumers into serving as the unwitting tools in the schemes . rarely do perpetrators tar shit only one insurance agent or either the public or secluded sector exclusively . Rather , most are effect to be defrauding several private and public sector victims , such(prenominal) as Medicare , simultaneouslyIn Medicare , the most common forms of fraud includeBilling for services not furnishedMisrepresenting the diagnosis to loose paymentSoliciting , offering , or receiving a kick backUnbundling or exploding chargesFalsifying certif! icates of health check checkup necessity , plans of treatment , and medical records to justify paymentBilling for a service not furnished as charge i .e , upcoding (Find Law 1998Now that we have an idea of what constitutes fraud , particularly the kind that can be committed against Medicare , we can now look more than closely into the case that knobbed Columbia /HCA hospitalsUn identical many hospitals , Columbia / HCA hospitals were obviously managed by a profit-oriented draw who put more emphasis on the money-yielding power of health care quite of the healing and caring aspect of the occupation . One key element that could have fostered the fraudulent appearance of the Columbia /HCA instruction is the party s strategy of doctor willpower . Doctors were given the chance to be deduct shareholders in the company -thus giving motivations to physicians to refer patients to its hospitals sooner of its competitors . Moreover , as shareholders of the hospital , doctors had mo re incentives to hold down costs or to concur with managerial directivesIt is , thus , not surp emerging to see how fraud could happen in such an environment . If doctors and hospitals are in it for the money , then in that location is no intimidate as to what they can do to get more financiallyJust looking at at the company vision or strategy of Columbia /HCA hospitals , we will see that ethics is clearly absent in the vision of direction . Instead of aiming to provide quality health care to its patients , the doctors and management of Columbia /HCA are more elicit in gaining more profit for the hospital and the corpo confine instead of giving excellent health care . While this may not be a meritless gesture in the over all scheme of things , it stock-still says a lot about the ethics of Columbia management . It would seem that the managers and doctors have lost the essence of their profession . let me qualify that at that place is nothing evil in wanting to operate on for money . What constitutes evil is applying fraudul! ent means to get more profitNow that we have an idea of what the chore is and where it lies , one recommendation that can be forwarded is the strengthening of ethics and values constitution in the medical community .

Doctors as well as everyone involved in the medical profession should understand that medicine is a calling , a vocation where money should come unoriginal to quality health careSecond recommendation would be to haul government into providing stricter procedure for health care , particularly for Medicare . As celebrated by the Concord bond website , wherever medical guidelines are hazy and judgment calls ar e required , it tries to ration claims finished arbitrary rules , creating a feast-or-famine reimbursement insurance . It imposes abundant meekness costs and produces capricious results . Worst of all , despite the estimated 45 ,000 pages of regulations , the arranging careens toward bankruptcy as costs keep rising (Concord Coalition 1997More importantly , it is important to set harsher penalties for Medicare fraud cases . This is to verify that hospitals like Columbia /HCA will learn from their mistakes and will advert as an example to all . Penalties must send the mental butt that fraudulent acts will not go punished and will be dealt with severely by the governmentConclusionIt goes without saying that the controversy anchor ring Medicare Columbia /HCA , and the health system in general is a disease that needs immediate diagnosis . The purpose of this is to erect awareness of the business affecting our health care exertion with the ultimate goal of finding the perfe ct solution to the problem . Needless to say Medicare! fraud hurts not just the beneficiaries or the members but the taxpayers in general . In other establish , it affects all AmericansThe raids that took place in the hospitals of Columbia /HCA should serve as a reminder that criminal acts will , sooner or later , be revealed and perpetrators will be brought to justice . In addition , we have learned from the case presented to us , that at that place is still need for improvement in terms of implementing the Medicare system . More importantly , we have seen that ethics plays a vast part in the Medicare scandal . It would seem that the management nates Columbia /HCA has forgotten the real reason behind their plaque . It is the belief of this author that a strengthening of ethics fundamental law in the medical community will help in changing the tides of Medicare fraudReferencesFind Law , 1998 : Medicare Definition of put-on [online]Available at : HYPERLINK hypertext transplant communications protocol / subroutine subroutine library .findlaw .com /1998 /Feb /19 /131383 .html hypertext change protocol /library .findlaw .com /1998 /Feb /19 /131383 .html[cited on : June 14 , 2006]Kansas Medicare , 2006 : Medicare Fraud [online]Available at : HYPERLINK hypertext transfer protocol / entanglement .kansasmedicare .com /policy /fraud .htm hypertext transfer protocol / vane .kansasmedicare .com /policy /fraud .htm[cited on : June 14 , 2006]Medicare , 2005 : Medicare Fraud [online]Available at : HYPERLINK hypertext transfer protocol / entanglement .medicare .gov /Fraud phone call out /Overview .asp http /www .medicare .gov /Fraud misuse /Overview .asp[cited on : June 14 , 2006]Mutual Medicare , 2006 : Help shrivel up the jounce of Medicare Fraud [online]Available at : HYPERLINK http /www .mutualmedicare .com /fraud http /www .mutualmedicare .com /fraud[cited on : June 14 , 2006]Senior Health , 2006 : Medicare Fraud and Abuse perception and Prevention Tips [online]Available at : HYPERLINK http /senio rhealth .about .com /library /medicare /blfraud .htm ! ?once true http /seniorhealth .about .com /library /medicare /blfraud .htm ?once true[cited on : June 14 , 2006]The Concord Coalition , 1997 : Medicare Fraud : A Symptom , non the Disease [online]Available at : HYPERLINK http /www .concordcoalition .org /facing-facts /ff_fax42 .html http /www .concordcoalition .org /facing-facts /ff_fax42 .html[cited on : June 14 , 2006]The Qui tam-o-shanter Online Network , 2006 : Common Types of Qui tam Fraud [online]Available at : HYPERLINK http /www .quitamonline .com /fraud .html http /www .quitamonline .com /fraud .html[cited on : June 14 , 2006]United Government Services , 2006 : Fraud and Abuse [online]Available at : HYPERLINK http /www .ugsmedicare .com /about_ugs /fraud_abuse .asp http /www .ugsmedicare .com /about_ugs /fraud_abuse .asp[cited on : June 14 , 2006]PAGEPAGE 5 ...If you want to get a full essay, order it on our website: OrderCustomPaper.com

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