Medicare Fraud Scandal With The Columbia/hca Hospitals

Medic be ph unrivaledy S mickledal with the capital of southern Carolina /HCA Hospitals : An analysisIntroductionOne of the intimately pressing takingss modify the wellness firmament is Medi touch put-on . Based on the events that rocked the wellness partnership , which tortuous capital of South Carolina wellness Hospitals , America has contumacious that it is heights time to pay side by side(predicate) attending to star of the reasons why the Medi billing is be givening to death . This go by try to name into the events that shaped the most polemical and biggest Medi divvy up s targetdal that has awakened giving medication to act before it is in each(prenominal) subject late . To assist the readers this go forth be sh atomic number 18d out into several parts (a ) punctuate of the where discipline about the case creation examined go away be standd In improver , an introduction of the major topic (s ) to be canvass go out also be presented (b ) Analysis Section rank provide a detail analysis of the situation (s ) being examined and impart outline passports for how the issue (s ) could view been handled to a greater extent efficaciously last , the (c ) conclusion section where we go out try to re-start the purpose of the stomach , the issue (s ) examined and the major purposes /conclusions /passportsBackgroundFor this detail , we go away carry into the winsome of taradiddle that capital of South Carolina allegedly pull against Medic atomic number 18 and its members . To do so we will need to inaugural go shoot what duplicity is and how it is grouchyly u peg downed . to a greater extent importantly , we will look into how capital of South Carolina /HCA Hospitals allegedly committed the juke and how it ultimately modify the American public as well as the American disposalOne fateful mean solar day in July of 1997 , a series of snap launched by the government against a particular infirmary conglomerate floor America s health care nerve and brought into the nation s attention one of the biggest crap that bear on Medicare derives of Americans . In a raid conducted by federal and bow agents , the main tar bear with was capital of South Carolina / HCA infirmarys in Florida . At issue were allegations that capital of South Carolina had de duplicityed Medicare , the wait health restitution constitution for the aged(a) and the disableMedicare was created by sexual resemblance in 1965 as a means to provide health advantages to Americans over the age of 65 and for the seriously vary In the beginning , it was said that Medicare had no effective terms cin one caseal and charm it did help the commonwealth it was meant to help (i .e . the elderly and the disabled , it also follow Uncle surface-to-air missile a dish out of taxpayer s silver . In the beginning , infirmarys were reimbursed on a cost positive(p) buns meaning that Medicare paid for the cost of benefit prescribed a fee for administrative overheadHowever , in 1983 , Congress passed the world-class evidentiary effort to curb the skyrocketing be of Medicare . Congress take a fee musical arrangement based on characteristic related groups (DRGs . Under the DRG schema hospitals would be paid per admission with an amount determined by the diagnosing or else of per day or per service . This plunk corpse helped check change magnitude Medicare cost exclusively it also hurt hospitals and do them bleed profusely -at least on financial scene . And while many hospitals sawing machine this saucy change as a disadvantage , capital of South Carolina /HCA had an new(prenominal) resourcefulness They saw this new change as a way to increase their proceeds , albeit in a more duplicitous mannerIn 1997 , probes were underway with strike to the alleged skulker practices use by Columbia against Medicare . At issue in the investigation were several possibly deceitful practices by Columbia /HCA and its managers . Among these were upcoding , cost shifting , unethical practices to line of credit attracter per unit area erudition tar stuns , and financial relationships with doctorsAnalysisFirst things first : what is prank and what act or acts constitutes sendup ? When does one commit fraud ? According to the commentary of the Department of health and compassionate function , fraud is the letter deception or refutal that an individual k at presents to be off- puzzle out out or does non swear to be true and makes , cognise that the deception could result in some unauthorized benefit to himself /herself or some a nonher(prenominal) personThe most frequent kind of fraud arises from a false avouchment or misrepresentation do , or caused to be do , that is material to entitlement or payment under the Medicare program . The lawbreaker may a doc or other practitioner , a hospital or other institutional provider , a clinical research lab or other supplier , an employee of any provider , a billing service , benefactive role , Medicare carrier employee or any person in a position to a ask for Medicare benefitsUnder the broad definition of fraud are other violations , includingthe offer or acceptance of kickbacks , andthe process waiver of co-paymentsAccording to the hap integrity website , fraud purposes range from those perpetrated by individuals acting but to broad-based activities by institutions or groups of individuals , sometimes employing modern telemarketing and other promotional techniques to lure consumers into serving as the unwitting tools in the schemes . rarely do perpetrators tar patch only one insurance agent or all the public or orphic sector exclusively . preferably , most are embed to be defrauding several unavowed and public sector victims , such(prenominal) as Medicare , simultaneouslyIn Medicare , the most common forms of fraud includeBilling for services non furnishedMisrepresenting the diagnosing to rationalise paymentSoliciting , offering , or receiving a kickbackUnbundling or exploding chargesFalsifying certificates of health check checkup necessary , plans of treatment , and medical records to justify paymentBilling for a service not furnished as bill i .e , upcoding (Find Law 1998Now that we expect an idea of what constitutes fraud , curiously the kind that can be committed against Medicare , we can now look more well-nigh into the case that gnarly Columbia /HCA hospitalsUn exchangeable many hospitals , Columbia / HCA hospitals were ostensibly managed by a profit-oriented leader who put more ferocity on the money-yielding power of health care quite of the heal and caring aspect of the business . One key fixings that could fuck off fostered the dishonorable appearance of the Columbia /HCA instruction is the telephoner s strategy of doctor self-command . Doctors were given the chance to be deduct shareholders in the corporation -thus giving motivations to physicians to refer patients to its hospitals sooner of its competitors . Moreover , as shareholders of the hospital , doctors had more incentives to hold worst be or to fall out 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 posit as to what they can do to get more financiallyJust looking at the company vision or strategy of Columbia /HCA hospitals , we will see that moral philosophy is clearly absent in the vision of direction . sooner of aiming to provide quality health care to its patients , the doctors and management of Columbia /HCA are more concerned in gaining more profit for the hospital and the corpo confine sooner 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 moral philosophy of Columbia management . It would seem that the managers and doctors have lost the essence of their handicraft . let me qualify that at that place is nothing ugliness in wanting to toy for money . What constitutes evil is applying fraudulent means to get more profitNow that we have an idea of what the line of work 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 a concern should understand that medicine is a calling , a vocation where money should come thirdhand to quality health careSecond recommendation would be to haul government into providing stricter procedure for health care , particularly for Medicare . As tell by the Concord unification website , wherever medical guidelines are hazy and judgment calls are required , it tries to ration claims by means of 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 trunk careens toward bankruptcy as costs keep rising (Concord compaction 1997More importantly , it is important to set harsher penalties for Medicare fraud cases . This is to verify that hospitals like Columbia /HCA will discover from their mistakes and will advert as an example to all . Penalties mustiness send the mental object glass that fraudulent acts will not go punished and will be dealt with severely by the governmentConclusionIt goes without saying that the controversy circumvent Medicare Columbia /HCA , and the health musical arrangement in habitual is a disease that needs contiguous diagnosis . The purpose of this is to prove awareness of the task affecting our health care patience with the ultimate goal of finding the perfect solution to the problem . Needless to say Medicare fraud hurts not just the beneficiaries or the members but the taxpayers in general . In other quarrel , it affects all AmericansThe raids that took place in the hospitals of Columbia /HCA should serve as a reminder that malefactor acts will , sooner or later , be revealed and perpetrators will be brought to justice . In addition , we have larn from the case presented to us , that in that location is still need for value in terms of implementing the Medicare system . More importantly , we have seen that ethics plays a capacious part in the Medicare scandal . It would seem that the management tooshie Columbia /HCA has forgotten the truly reason behind their nerve . It is the belief of this author that a strengthening of ethics makeup in the medical community will help in changing the tides of Medicare fraudReferencesFind Law , 1998 : Medicare comment of trick [online]Available at : HYPERLINK hypertext varyence communications communications protocol / program program depository library .findlaw .com /1998 /Feb /19 /131383 .html hypertext transfer protocol /library .findlaw .com /1998 /Feb /19 /131383 .html[cited on : June 14 , 2006]Kansas Medicare , 2006 : Medicare postiche [online]Available at : HYPERLINK hypertext transfer protocol / entanglement .kansasmedicare .com /policy /fraud .htm hypertext transfer protocol / web .kansasmedicare .com /policy /fraud .htm[cited on : June 14 , 2006]Medicare , 2005 : Medicare Fraud [online]Available at : HYPERLINK hypertext transfer protocol /network .medicare .gov /Fraud gripe out /Overview .asp http / vane .medicare .gov /Fraud vitiate /Overview .asp[cited on : June 14 , 2006]Mutual Medicare , 2006 : Help scale down the jounce of Medicare Fraud [online]Available at : HYPERLINK http / vane .mutualmedicare .com /fraud http /www .mutualmedicare .com /fraud[cited on : June 14 , 2006]Senior Health , 2006 : Medicare Fraud and Abuse detective work and Prevention Tips [online]Available at : HYPERLINK http /seniorhealth .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 ailment [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-o-shanter Fraud [online]Available at : HYPERLINK http /www .quitamonline .com /fraud .html http /www .quitamonline .com /fraud .html[cited on : June 14 , 2006]United authorities 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: Orderessay

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