6. As you try to understand the fact that tens of billions of dollars are lost t

Question

6. As you try to understand the fact that tens of billions of dollars are lost to fraud, is it the number that is troublesome or the fact that nobody can agree on an estimate? What is being done and can be done to reduce fraud and prevent it?

7. You are the new compliance manager for a health care organization. Describe the steps you will take to ensure that your compliance plan is legal and effective.

8. A physician and his colleague decide to set up a laboratory owned by a dummy corporation in their wives’ names and begin to refer patients to this laboratory. What (if any) laws have they violated?

9. A psychiatrist bills for 10 hours of psychotherapy and medication checks for a deceased woman. Has he committed fraud or abuse? Can the deceased woman’s estate press charges if the bills were sent to Medicare, and not to the family?

10. An attorney sees a plastic surgeon and is so happy with her face-lift that she begins to refer all her friends and family. At her 6-month follow-up, she says, “So, Doc, I’ve sent you all these patients, where’s my 30% cut of your fees?” What should the plastic surgeon do?

11. While working on your homework for this course and surfing the Internet to check out all the fascinating links, you realize the person who manages the branch of the new durable medical equipment company (DMExcellence) where you work looks just like someone on the OIG Most Wanted list. He even has the same first name! And he has a wife who looks like the woman on the list with him! While you really need this new job to help pay your way through school, you have a sinking feeling all is not good at DMExcellence. What do you do?

Explanation / Answer

As you try to understand the fact that tens of billions of dollars are lost to fraud, is it the number that is troublesome or the fact that nobody can agree on an estimate?What is being done and can be done to reduce fraud and prevent it .

Definitely it's the fact that nobody is agreeing on the estimation of the total lost funds in the specific fraud. In this situation people who get affected by the fraud would try to find the root cause of the fraud but the people who got benefited by the same would not do anything in contribution to take the fraud in broad light.

You are the new compliance manager for a healthcare organization. Describe thesteps you will take to ensure that your compliance plan is legal and effective.

Implementation of a better compliance plan manager should widely describe specific plan to the Employees and make sure that each and every employee inside your organisation knows about the plant which has been implemented. Conduction of forest assessment process inside an organisation would be beneficial for determining the best available strategy for implementing the Compliance plan. According to the risk management plans, overall compliance plan should be developed.

8. A physician and his colleague decide to set up a laboratory owned by a dummy corporation in their wives’ names and begin to refer patients to this laboratory. What (if any) laws have they violated?

Yes in this specific case, positions have violated STARK I law in which it is stated that positions are not allowed to refer to any laboratory that has any financial benefits for the physicians.

9. A psychiatrist bills for 10 hours of psychotherapy and medication checks for a deceased woman. Has he committed fraud or abuse? Can the deceased woman’s estate press charges if the bills were sent to Medicare, and not to the family?

In this specific case the psychiatrist has done an intentional fraud because the billing services was not rendered to the disease women. Deceased womens family can easily press the charges against the psychiatrist as there is Shiv temple against the services which were never received by the deceased women which is a clear fraud from the side of the psychiatrist.

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