Healthcare: Health Insurance and Fraud E. Ethical

pretender, flub and Abuse in the Medicare System A Proactive onslaught Course Project Outline police squad A The Prairie State Bulls Julie GIldemeister Elena Hallars Teresa OBrien Latia Phelps Laura Wimberley HSM 546 health Insurance and Managed Care Vernice Johnson-Warren Keller Graduate give lessons of Business Management March 17, 2013 outline We propose to discuss the problem of blind, barren and abuse in Medicare and Medicaid from the viewpoint of a board of directors of a community healthcare constitution.We agree that a proactive railway line of action, while initially more expensive, go forth result in a furthermost better outcome for the system, its providers, and its patients. It will need to better transaction not totally with the government but also with our technical MCO plans. This issue will be turn to on several fronts legislative loopholes, weaknesses in electronic technology, ethical lapses on the demote of providers, and enforcement failures. I . Executive Summary A. Environment B. Rules and regulations of Medicare and Medicaid C.wellnesscare meliorate Legislation D. Problems with artifice E. respectable Considerations of humbug II. Problem Statement A. bosh, waste and abuse in the Medicare and Medicaid system B. Legislative loopholes C. Weaknesses in electronic medical records D. Ethical lapses in providers E. Common errors in billing and mark F. Enforcement failures III. Literature Review A. Course textual matter B. Fraud, waste and abuse of Medicare/Medicaid funds C. IT and EMR issues D. Ethical training of providers E. Enforcement failures IV. Problem Analysis A.Identification of opportunities for fraud in a healthcare system B. Enforcement of Medicare/Medicaid claims reporting regulations C. Counteracting or preventing a clime of fraud waste and abuse V. Solutions and performance A. Streamlining enforcement efforts B. Tightening IT loopholes C. Creating provider incentives for responsible doings in coding an d billing D. linguistic rule review and claims review to catch trends declarative of fraud, waste or abuse VI. vindication A. Cost of fraud, waste and abuse, especially in Medicare claims reclamation processesB. Cost of failure to accede with rules and regulations C. emolument in facility/provider/payer relations D. Improvement in cash flow and claims payment E. Improvement in patient and community relations VII. Conclusion VIII. References Aldhizer III, G. R. (2009). Medicare and Medicaid Fraud and Errors A tick Time Bomb That Must be Defused. journal Of Government Financial Management, 58(4), 12-20. Boerner, C. M. (2010). 60 Minutes Story on Medicare Fraud. journal Of health Care Compliance, 12(1), 29-65. Dietz, D. K. , &038 Snyder, H. 2007). Internal adjudge differences between community health centers that did or did not experience fraud. Research In Healthcare Financial Management, 11(1), 91-102. Evans, R. D. , &038 Porche, D. A. (2005). The nature and oftenness of med icare/medicaid fraud and neutralization techniques among speech, occupational, and physical therapists. unnatural Behavior, 26(3), 253-270. doi10. 1080/01639620590915167. Hambleton, M. (2011). Los Angeles Health Care Fraud Prevention Summit Moving from a Sickness to Wellness Model of Compliance.Journal Of Health Care Compliance,13(1), 19-24. Hoppel, A. M. (2012). Career Code Red. (Cover story). Clinician Reviews, 22(10), 1-8. Kongstvedt, P. R. (2007). Essentials of Managed Health Care (5th ed). Sudbury, MA Jones &038 Bartlett. Moses, R. E. , &038 Jones, D. (2011). Physician Assistants in Health Care Fraud vicarious Liability. Journal Of Health Care Compliance, 13(2), 51-75. Robin, D. W. , &038 Gershwin, R. J. (2010). RAC blowMedicare Recovery Audit Contractors What Geriatricians Need to Know. Journal Of The American Geriatrics Society, 58(8), 1576-1578. oi10. 1111/j. 1532-5415. 2010. 02974. x Sparrow, M. K. (2008). Fraud in the U. S. Health-Care System Exposing the Vulnerabilities of Automated Payments Systems. fond Research, 75(4), 1151-1180. Steinhoff, J. C. (2008). FORENSIC AUDITING A Window to Identifying and Combating Fraud, Waste and Abuse. Journal Of Government Financial Management, 57(2), 10-15. Thorpe, N. , Deslich, S. , Sikula, S. , &038 Coustasse, A. (2012). Combating Medicare Fraud A Struggling Work In Progress. Franklin Business &038 Law Journal, 2012(4), 95-107.