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Fraud, Waste and Abuse in the Medicare System: A Proactive Way Course Project Outline Group A: The Prairie Point out Bulls Julie GIldemeister Elena Hallars Teresa O’Brien Latia Phelps Laura Wimberley HSM 546 Health Insurance and Managed Care Vernice Johnson-Warren Keller Graduate School of Business Supervision March 17, 2013 Suite We offer to discuss the problem of fraudulence, waste and abuse in Medicare and Medicaid in the viewpoint of any board of directors of your community health care system.

We all agree a proactive alternative, while initially more expensive, will mean a greater outcome for the system, their providers, and its patients. It is going to lead to better relations not simply with the federal government but in addition to our commercial MCO strategies.

This issue will probably be addressed in several methodologies: legislative weaknesses, weaknesses in electronic technology, ethical ciel on the part of companies, and enforcement failures. We. Executive Brief summary A. Environment B. Rules of Medicare health insurance and Medical planning C.

Health-related Reform Legislation D. Issues with Fraud Elizabeth. Ethical Things to consider of Fraudulence II. Trouble Statement A. Fraud, spend and abuse in the Medicare insurance and Medicaid system W. Legislative weaknesses C. Disadvantages in electronic medical data D. Ethical lapses in providers E. Common errors in invoicing and coding F. Enforcement failures III. Literature Assessment A. Course text W. Fraud, waste materials and abuse of Medicare/Medicaid funds C. IT and EMR problems D. Ethical training of providers At the. Enforcement failures IV. Difficulty Analysis A.

Identification of opportunities intended for fraud within a healthcare system B. Enforcement of Medicare/Medicaid claims reporting regulations C. Counteracting or preventing a climate of fraud spend and misuse V. Alternatives and Implementation A. Efficiency enforcement efforts B. Tightening up IT loopholes C. Creating provider offers for accountable behavior in coding and billing G. Pattern review and promises review to catch styles indicative of fraud, waste or abuse VI. Approval A. Expense of fraud, waste and misuse, especially in Medicare claims reclamation processes

N. Cost of failing to adhere to rules and regulations C. Improvement in facility/provider/payer relationships D. Improvement in income and promises payment Electronic. Improvement in patient and community relations VII. Summary VIII. References Aldhizer 3, G. Ur. (2009). Medicare insurance and Medical planning Fraud and Errors: A Ticking Period Bomb That needs to be Defused. Log Of Government Economic Management, 58(4), 12-20. Boerner, C. M. (2010). 60 Minutes Story upon Medicare Fraudulence. Journal Of Health Care Complying, 12(1), 29-65. Dietz, Deb. K., , Snyder, L. 2007). Interior control variations between community health centers that performed or did not experience scams. Research In Healthcare Financial Management, 11(1), 91-102. Evans, R. D., , Cobertizo, D. A. (2005). The type and rate of recurrence of medicare/medicaid fraud and neutralization methods among presentation, occupational, and physical therapists. Deviant Habit, 26(3), 253-270. doi: twelve. 1080/01639620590915167. Hambleton, M. (2011). Los Angeles Medical Fraud Avoidance Summit: Going from a Sickness to Wellness Type of Compliance.

Log Of Healthcare Compliance, 13(1), 19-24. Hoppel, A. M. (2012). Job Code Crimson. (Cover story). Clinician Testimonials, 22(10), 1-8. Kongstvedt, P. R. (2007). Essentials of Managed Health Care (5th ed). Sudbury, MA: Jones , Bartlett. Moses, R. E., , Williams, D. (2011). Physician Assistants in Health Care Fraud: Vicarious Liability. Journal Of Health Care Conformity, 13(2), 51-75. Robin, G. W., , Gershwin, L. J. (2010). RAC Attack”Medicare Recovery Review Contractors: What Geriatricians Need to learn. Journal Of The American Geriatrics Society, 58(8), 1576-1578. oi: 10. 1111/j. 1532-5415. 2010. 02974. x Sparrow, Meters. K. (2008). Fraud inside the U. T. Health-Care System: Exposing the Vulnerabilities of Automated Obligations Systems. Social Research, 75(4), 1151-1180. Steinhoff, J. C. (2008). FORENSIC AUDITING: A Window to Identifying and Combating Fraud, Waste and Abuse. Record Of Government Economic Management, 57(2), 10-15. Thorpe, N., Deslich, S., Sikula, S., , Coustasse, A. (2012). Dealing with Medicare Scam: A Unable Work In Improvement. Franklin Organization , Regulation Journal, 2012(4), 95-107.

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