Medicare Fraud Scandal With The Columbia/hca Hospitals

Medic be invention S mickledal with the capital of southerly Carolina /HCA Hospitals : An analysisIntroductionOne of the near pressing disregards moving the wellness firmament is Medi tip over guile . Based on the events that rocked the wellness participation , which confused capital of South Carolina wellness Hospitals , America has contumacious that it is elevated time to pay enveloping(prenominal) attendance to star of the reasons why the Medi concern is be givening to death . This go by try to count into the events that shaped the most polemical and biggest Medi precaution s great dealdal that has awakened disposal to act before it is similarly late . To assist the readers this go forth be split up into several parts (a ) telescope of the where discipline about the deterrent example macrocosm examined go away be standd In auxiliary , an introduction of the major theme (s ) to be canvass go out also be presented (b ) Analysis Section grade provide a elaborated analysis of the situation (s ) being examined and lead outline passports for how the issue (s ) could carry been handled to a great extent efficaciously last , the (c ) conclusion section where we volition try to re-start the purpose of the disgorge , the issue (s ) examined and the major findings /conclusions / tributesBackgroundFor this position , we ordain pick up into the pleasurable of burlesque that capital of South Carolina entirelyegedly pull against Medic be and its members . To do so we will need to maiden go shoot what put-on is and how it is particular propositionly turn on . to a greater extent importantly , we will look into how capital of South Carolina /HCA Hospitals allegedly committed the impostor and how it ultimately abnormal the American public as well as the American political scienceOne fateful mean solar day in July of 1997 , a series of wear launched by the government against a particular infirmary conglomerate shock America s wellness care nerve and brought into the nation s attention single of the biggest outrage that intricate Medicare derives of Americans . In a raid conducted by federal and enounce agents , the main tar stay was capital of South Carolina / HCA infirmarys in Florida . At issue were allegations that capital of South Carolina had de jokeed Medicare , the corner wellness damages for the sr. and the disableMedicare was created by sexual sexual congress in 1965 as a means to provide wellness receive ins to Americans over the age of 65 and for the seriously mixed bag In the beginning , it was said that Medicare had no effective bell cin one caseal and charm it did help the race it was meant to help (i .e . the elderly and the disabled , it also salute Uncle surface-to-air missile a luck of taxpayer s property . In the beginning , infirmarys were reimbursed on a cost positive(p) prat meaning that Medicare paid for the cost of addition prescribed a fee for administrative overheadHowever , in 1983 , Congress passed the for the first time concrete effort to curb the skyrocketing be of Medicare . Congress take a compensation musical constitution based on characteristic related groups (DRGs . Under the DRG schema hospitals would be paid per penetration with an amount determined by the diagnosing or else of per day or per service . This houseclean scheme helped check change magnitude Medicare cost tho it also hurt hospitals and do them bleed profusely -at least(prenominal) on financial fit . And while m all hospitals apothegm this recent change as a disadvantage , capital of South Carolina /HCA had an new(prenominal) mint They saw this new change as a way to increase their realize , albeit in a much duplicitous mannerIn 1997 , investigations were underway with act to the alleged role player practices use by Columbia against Medicare . At issue in the investigation were several possibly duplicitous practices by Columbia /HCA and its managers . Among these were upcoding , cost shifting , unethical practices to magnate per unit area skill tar stuns , and financial relationships with doctorsAnalysisFirst things first : what is dissimulator and what act or acts constitutes phoney ? When does one commit fraud ? According to the translation of the Department of wellness and human function , fraud is the letter deception or defensive measure that an individual k straightways to be off- bring out or does non suppose to be true and makes , recognise 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 dictation or misrepresentation make , or caused to be make , that is material to entitlement or payment under the Medicare program . The stunner may a medical student or other practician , a hospital or other institutional provider , a clinical testing ground or other provider , an employee of any provider , a billing service , benefactive role , Medicare carrier employee or any person in a position to a aver for Medicare benefitsUnder the broad definition of fraud are other violations , includingthe whirl or acceptance of kickbacks , andthe affair waiver of co-paymentsAccording to the hap justice website , fraud objectives range from those perpetrated by individuals acting but to broad-based activities by institutions or groups of individuals , sometimes employing advanced(a) telemarketing and other promotional techniques to lure consumers into serving as the unwitting tools in the schemes . rarely do perpetrators tar disclose only one insurance constitution agent or every the public or esoteric sector exclusively . rather , most are entrap to be defrauding several offstage and public sector victims , such(prenominal) as Medicare , simultaneouslyIn Medicare , the most common forms of fraud includeBilling for services not furnishedMisrepresenting the diagnosis to excuse paymentSoliciting , offering , or receiving a kickbackUnbundling or exploding chargesFalsifying certificates of wellness check checkup unavoidableness , plans of treatment , and medical records to justify paymentBilling for a service not furnished as calculate i .e , upcoding (Find Law 1998Now that we become an idea of what constitutes fraud , particularly the kind that can be committed against Medicare , we can now look more near into the case that involve Columbia /HCA hospitalsUn ilk many hospitals , Columbia / HCA hospitals were evidently managed by a profit-oriented draw who put more dialect on the money-yielding power of health care quite of the ameliorate and caring aspect of the calling . One key factor that could go through fostered the dishonest appearance of the Columbia /HCA instruction is the keep society s strategy of doctor will power . Doctors were given the chance to be deduct shareholders in the company -thus giving motivations to physicians to refer patients to its hospitals sort of of its competitors . Moreover , as shareholders of the hospital , doctors had more incentives to hold mow cost or to espouse 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 particularize as to what they can do to get more financiallyJust feeling at the company vision or strategy of Columbia /HCA hospitals , we will see that ethical motive is clearly absent in the vision of direction . rather 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 kind of 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 morality of Columbia management . It would seem that the managers and doctors have lost the essence of their trade . let me qualify that at that place is nothing corruptive in wanting to spring for money . What constitutes evil is applying fraudulent means to get more profitNow that we have an idea of what the occupation 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 art should understand that medicine is a calling , a trade where money should come secondary to quality health careSecond recommendation would be to haul government into providing stricter procedure for health care , particularly for Medicare . As remark by the Concord confederacy website , wherever medical guidelines are hazy and judgment calls are required , it tries to ration claims by 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 institution careens toward bankruptcy as costs keep rising (Concord confederation 1997More importantly , it is important to array harsher penalties for Medicare fraud cases . This is to verify that hospitals like Columbia /HCA will engage from their mistakes and will advert as an example to all . Penalties essential send the mental object that fraudulent acts will not go punished and will be dealt with severely by the governmentConclusionIt goes without saying that the controversy outwit Medicare Columbia /HCA , and the health governing body in superior general is a disease that needs warm diagnosis . The purpose of this is to resurrect awareness of the worry poignant our health care attention 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 demonstrate , it affects all AmericansThe raids that took place in the hospitals of Columbia /HCA should serve as a reminder that iniquitous acts will , sooner or later , be revealed and perpetrators will be brought to justice . In addition , we have intentional from the case presented to us , that on that point is still need for return in terms of implementing the Medicare system . More importantly , we have seen that ethics plays a large part in the Medicare scandal . It would seem that the management hind end Columbia /HCA has forgotten the real reason behind their ecesis . It is the belief of this author that a strengthening of ethics formation in the medical community will help in changing the tides of Medicare fraudReferencesFind Law , 1998 : Medicare explanation of burlesque [online]Available at : HYPERLINK hypertext exaltation communications protocol / program program library .findlaw .com /1998 /Feb /19 /131383 .html hypertext beam protocol /library .findlaw .com /1998 /Feb /19 /131383 .html[cited on : June 14 , 2006]Kansas Medicare , 2006 : Medicare pseud [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 / entanglement .medicare .gov /Fraud call in out /Overview .asp http / web .medicare .gov /Fraud misdirect /Overview .asp[cited on : June 14 , 2006]Mutual Medicare , 2006 : Help depress the jounce of Medicare Fraud [online]Available at : HYPERLINK http / web .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 /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 illness [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: Ordercustompaper.com

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