ipl-logo

Case Study: Health Care Fraud

1963 Words8 Pages

PART I
PRELIMINARY

1.1 Background
If you see a news show on television, the most frequent topic dibicarkan is a corruption or fraud committed by individuals, non-profit organizations, corporations, and Government.
By 2016, there is news that Safely Commission Corruption suspect the flow of funding from pharmaceuticals to doctors. The presence of invetigasi from Tempo magazine alleged gratuities increasingly strengthen doctors from pharmaceutical companies that menginkan products a cure was made a prescription for the patient's doctor.
The Crime is one type of healthcare fraud relative seldom heard in Indonesia. Health Care Fraud is done doctors, medical personnel, health equipment suppliers, healthcare providers, to insurance companies. …show more content…

Medical departments and administration. Medical units include; emergency room, surgical suite, intensive care unit (ICU), as well as the mother and child unit of the Department, including Anesthesiology, radiology, pathology and rehabilitative medicine. While the Administration Department consists of; Accounting Department, human resources department, internal audit department, as well as medical records. The internal audit Department of which there is an internal Watchdog Unit (a unit of Functional Work in charge of carrying out internal oversight at the hospital. Internal oversight unit is responsible to and under the direction of the hospital and also established and defined by the leaders of the hospital), Committee (non structural Units consisting of experts or profession which was formed to give consideration to the strategic direction of the hospital in order to increase and development of hospital services. Committee on the set by the leadership of the hospital as needed which consists of the Medical Committee and the Committee of ethics and the law. The Committee is headed by a Chairperson who is appointed and dipilihm defined by the direction of the hospital. In terms of the formation and changes of the number and type of committees, the Chairman of the hospital needs the approval of the Director-General of Medical Service of community development), Installation (non-structural Service Unit that provides the facilities and organizing activities, education and research hospital). One of the components that are instrumental in the process of implementation of good corporate governance is the audit committee. The Influence of the audit committee in ensuring the quality of financial reporting of the company has become the spotlight since the onset of the accounting scandal became public

Show More
Related

  • Guy Ross Health Care Fraud Case

    216 Words  | 1 Pages

    Page 1 of 2 Caterra Bruno05/17/2018HS115A medical assistant was sentenced today to 36 months in prison for his role in a conspiracy to defraud the Medicare program, the Departments of Justice and Health and Human Services announced. Guy Ross was also sentenced by U.S. District Judge Denise Page Hood in the Eastern District of Michigan to three years of supervised release following his prison term and was ordered to pay $472,623 in restitution. Ross, 51, pleaded guilty in July 2010 to one count of conspiracy to commit health care fraud. According to court documents, Ross received kickbacks from the owners and/or operators of two Detroit-area home health agencies, Patient Choice Home Healthcare Inc. and All American Home Care Inc., in exchange

    Read More

  • Unit 3 Assignment 1 Medical Identity Theft

    132 Words  | 1 Pages

    There are some many ways if Identity theft. There is when someone uses a person name, social security number. Medical Identity theft can come from a Friend, family, and acquaintances. Even by strangers, who can steal someone 's Identity who can obtain medical care, service, or equipment. They don 't have medical care.

    Read More

  • Affordable Care Act Case Study

    158 Words  | 1 Pages

    An estimated 50 million Americans are relied upon to pick up medical coverage through the Affordable Care Act (ACA), and a sound and sizable workforce will be expected to take care of the expanded demand. The medicinal services workforce is as of now confronting a basic deficiency of healthcare experts throughout the following decade. The ACA breaks the guarantees of access and nature of administer to all Americans by raising the lack and expanding the weight and weight on the officially delicate framework. The ACA's endeavors to address the deficiency are doubtful and constrained in degree, and the noteworthy monetary venture won't create results for quite a long time because of the preparation pipeline. With the ACA's evaluated 190 million

    Read More

  • Affordable Care Act Case Study

    576 Words  | 3 Pages

    Patient Protection and Affordable Care Act, or ‘Obamacare’ was the expansion of Medicaid program across the states. Charles Barrilleaux and Carlisle Rainey look at why state government have opted out of the Medicaid expansion. They find that Obama’s 2012 vote share and the governor’s partisanship better explains the disapproval to Medicaid expansion, rather than measures of need, such as life expectancy or the number of people that are uninsured. Charles Barrilleaux and Carlisle Rainey find that a Republican governor is a higher percentage point more likely to oppose the expansion than Democratic governors. Whereas, the results show that the percentage uninsured in the state to have a small positive effect on the probability of opposition.

    Read More

  • Medicaid Managed Care Case Study

    1059 Words  | 5 Pages

    Over the last few decades, managed health care has revolutionized the way medicaid beneficiaries treat essential healthcare services such as family planning and parenthood programs. The term managed care is a health insurance plan or system that allocates the provisions, quality and cost of caring for an individual. It has an significant role when it comes to providing health care services to medicaid members and the ways it’s utilized. Managed care plans create contracts with health care providers and medical institutions that help provide services at a lower and more affordable cost to their members. Additionally, managed care plans tend to pay health care providers directly so that it’s members don’t have to pay out of pocket for services

    Read More

  • Affordable Care Act Case Study

    991 Words  | 4 Pages

    The affordable care act presented the United States with the most extensive overhaul since the passage of Medicare and Medicaid in the 1960’s. The act was a response to staggering statistics on the price of healthcare and the resulting uninsured rate within the United States. The affordable care act uses Individual Mandate and Health Insurance Exchanges to combat major factors causing high insurance cost and low insured rates. As with most reform, the public has not been one hundred percent unified on the potential effectiveness of the Affordable Care Act.

    Read More

  • Affordable Care Act Case Study

    157 Words  | 1 Pages

    You are absolutely right . We, as medical providers have a widely acknowledged role in improving health and preventing illness. Every interaction with a patient is an opportunity to improve long-term health. I think that partnering with other local services, such as pharmacies, schools and community groups , we can can ensure that the 'whole is greater than the sum of the parts' in the fight to improve health and well-being in the community.

    Read More

  • Ethical Issues In Managed Care

    421 Words  | 2 Pages

    Today's health care system is difficult to understand. It has undergone dramatic changes over the years. There are many changes that shift the movement from "an indemnity plan to a managed care system. " Not only has the U.S. health care system undergone dramatic changes, but as well continues to evolve to a rapid pace (Conklin, 2002).

    Read More

  • Medicare Fraud Research Paper

    301 Words  | 2 Pages

    Medicare fraud is a very common occurrence in the United States. However, there are whistleblowers who are working hard to stop Medicare fraud. The vast majority of people who report Medicare fraud are healthcare professionals. This includes people such as ambulance drivers, physicians, nursing home workers, hospice workers and nurses. There have been some changes recently to the United States whistleblower laws.

    Read More

  • Sheppard Pratt Health Systems: A Case Study

    1011 Words  | 5 Pages

    Decisions facing the whole organization are made in a top-down model. Everyday decisions would be made by the individual departments or units of the hospital in accordance with policy. Conflicts are addressed within each department or unit based on policies that have been set in place by the executive board and the directors. Allocation of scarce resources when affecting the whole system would be handled by the trustees, executive board, and the directors. Each unit and department has a budget it must follow to keep resources from becoming

    Read More

  • Managed Care Case Study

    858 Words  | 4 Pages

    You are a new physician setting up your practice in a new town. You are researching the different MCOs offered in your area and are considering becoming a physician for one of these networks. You have also invited the sales representatives of several healthy plans to speak with you about the benefits of choosing their plans. Based on the above scenario, answer the following questions: • What effects would join an MCO have your clinic regarding staffing, patient volume, and financial stability?

    Read More

  • Pros And Cons Of Electronic Prescription Drug Corruption

    1084 Words  | 5 Pages

    The complexities brought about by the involvement of a large number of different agencies and jurisdictions in the investigation and prosecution of drug crimes creates opportunities for corruption. This form of Corruption of criminal justice personnel, by those involved in illegal drugs is principally exercised through bribery. The bribe is often in form of cash though a times the drugs themselves serve as bribes. Any office that works in the criminal justice is a target of the corruption. From local police and sheriffs to state narcotics officers; State Customs, Immigration, and Coast Guard personnel, local, state regulatory officials; and prosecutors and judges at all levels.

    Read More

  • Healthcare Disparities In Health

    898 Words  | 4 Pages

    Introduction Disparities in health are an inequality that occurs in the provision of healthcare and its accessibility across different dimensions including location, gender, ethnicity, age, disability status, citizenship status and socioeconomic group (Ubri & Artiga, 2016; Wallerstein & Durran, 2006). According to the health Resources and Service Administration of United States, health disparities are defined by population specific differences in the presence of disease, health outcomes and the accessibility to healthcare. Urbi and Artiga (2016) indicates that disparities in healthcare provision not only bring impacts to the group facing disparities, but also limit overall improvements in quality of care and population health as well as resulting

    Read More

  • Tort Case Study: Health Care Law

    1368 Words  | 6 Pages

    Health Care Law: Tort Case Study Carolann Stanek University of Mary   Health Care Law: Tort Case Study A sample case study reviewed substandard care that was delivered to Ms. Gardner after having sustained an accident and brought to Bay Hospital for treatment. Dr. Dick, a second-year pediatric resident, was on that day in the ED and provided care for Ms. Gadner. Dr. Moon, is the chief of staff and oversees the credentialing of all physicians at Bay Hospital.

    Read More

  • Role Of Corporate Governance In Nestle

    1346 Words  | 6 Pages

    As stated in Principle 1, The Board of Directors directs the Group’s risk assessment, strategic planning, succession planning and financial and operational management to ensure that obligations to shareholders and other stakeholders are understood and met. The board of directors has a collective responsibility for the management of the group to make sure the group is on the way to approach to their objectives while the non-Executive Directors are responsible for bringing independent judgment and scrutiny to decisions taken by the Board of Directors and providing objective challenges to management. Besides, the board of directors also function as formalising and adopting a set of Code of Ethics through the Code of Conduct as Recommendation 1.3 as stated in the Malaysian Code on Corporate Governance 2012 to make sure its compliance, establishing an appropriate set of corporate disclosure policies and procedures and ensuring a whistleblowing mechanism is in place. The Board of Directors recognizes the importance of independence and objectivity in its decision making process. The Directors are professionals of high calibre and integrity and possess in-depth knowledge and experience of the business to enable them to discharge their duties effectively.

    Read More

More about Case Study: Health Care Fraud

Open Document