HGMT372 University of Maryland Week 3 Financial Management in Health Care Organizations Paper

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ghzoryvan

Health Medical

HGMT372

University of Maryland University College

Description


From the topics covered in Weeks 3-4, select one law related to financial management in health care organizations. We discussed such laws as False Claims Act, Stark Law etc. Include a cover page and a list of references at the end of the paper in APA Format. Paper will be double spaced and be 4-5 pages in 12 point New Times Roman font.

The assignment is to be written in clear, concise narrative. All sections in the outline for Assignment #2 are required.

Outline: Must use the headings from the outline below in your paper and the paper must be in narrative form not outline or bullet format. A penalty will be deducted from paper if underlined headings not used in your paper.

1. Name of the Law and or laws:

State the official title of the federal and/or state law, the statute and section number. Must be either a federal statute or state statute and you must cite both if applicable. Thus if there is both a federal and state law that covers your subject picked then you must cite both. Do not assume that there is just a federal and or state law. In most cases there is both a federal and state law. You must use the laws cited in this section throughout the rest of the paper.

2. Management’s Financial Responsibilities:

What are the health care organization’s responsibilities under this financial management statute you stated above? Provide a comprehensive discussion of three (3) specific responsibilities under the financial management statute. State specifically after each responsibility where this responsibility is stated in the federal or state law. Describe the appropriate behavior and expectation. Include the citations and source of documents describing the organization’s responsibilities.

  1. Consequences for Ethical or Legal Breach:

Discuss in general the civil and criminal consequences from the law. Then identify from the news, three (3) specific case examples of health care organizations or health care providers found guilty of a legal or ethical breach relative to the law you have cited in first part of paper. Identify the specific legal and/or ethical breach and the penalties assessed to the health service organizations and/or individuals found guilty of violating the law or ethics [provide citation of law]. At the end of each case, discuss in detail whether you agree or not with the decision and why. Bring in the facts of the case to support your comments. Students should use a minimum of three (3) documented specific examples retrieved from the print media.

  1. HCO Management’s remedial steps to reverse the non-compliance organizations:

Describe in detail three (3) specific management actions or remedial steps you would take to ensure the financial management in the health care organization meets or exceeds the federal law or state law relative to the requirements of the law you cited above. Discuss specifically how each of the three management actions specifically meets or exceeds the specific federal or state law you cited. Note: These actions may include specific uses of technology, procedures, human resource training, and other management tools. However these action steps must be within the control of a manager.

5. Conclusion: Summary your findings above

  1. Reference List [APA Format]

The paper must be:

  • Late penalties: See Course Syllabus.
  • Be sure and use the underlined headings found in the outline below in your paper. Paper must be in narrative format not outline or bullets.
  • Double spaced and be 4-5 pages in 12 point New Times Roman font.
  • Include a cover page [not counted as a page] which should have student name and title of your paper [Provide a short name for the legal responsibility the specific health care organization has for one type of patient right in a specific setting ]
  • A the end of the paper a list of references in APA Format [not counted as a page]
  • Be prepared using word-processing software and saved with a .doc, .docx, or .rtf extension. No pdf.
  • Be uploaded to your Assignments Folder by 11:59 p.m. EST on the due date.
  • The paper is to be posted in Assignment #2 drop box.
  • Must cite to the source for all your facts in the text of your paper in APA format.

Example of an in text citation:

(Ernst, & Young, 2000 p14).

Example of source cited on Reference page:

References

Healthcare Financial Management Association (U.S.), Ernst, & Young. (2000). Health care system reform: A provider perspective : survey results. Westchester, Ill.: Healthcare Financial Management Association.

Except where noted, the assignment is written in clear, concise narrative. All sections of Assignment #2 are required.

Grading Rubric for written Assignment #2 is in Assignments area of the class.

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Explanation & Answer

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Running Head: FALSE CLAIMS ACT

1

Student Name
Prevention of False Claims

FINANCIAL MANAGEMENT IN HEALTHCARE
Name of the Law and or laws:
The federal False Claims Act, 31 U.S.C § 3729-3733. Another similar law adopted from
federal law is the “Michigan Medicaid False Claims Act (MMFCA) (Mich. Comp. Laws.
§§400.601-400.615.).” This statute is designed to help prevent conspiracies, kickbacks, and fraud
concerning the Medicaid program.
Management’s Financial Responsibilities
This federal law makes it a criminal activity for an organization or an individual who
knowingly file false claims or make false records regarding a national health care program.
Health care programs include any program or plan that provides health benefits, either directly,
via insurance or other ways which are funded directly, in part or whole, by a state health care
system or the United States government. This statute helps in fighting fraud activities against the
U.S. government. Not only does the law benefit the government and its residents, but also it
benefits the person with the information or the whistleblower.
The federal false claims act shows liability when an organization knowingly submits false
claims seeking payment from the government “(31 U.S.C. 3729(a)(1)(A)).”. The act also is held
liable when it knowingly avoids payments they owe to the government. A claim is defined as
requests for property or money that is directly owned by the government (Patel, K. I. R. A. N., &
Sherer, 2016). Knowingly represents that there could be deliberate ignorance, reckless disregard,
or actual knowledge of the claim to be false or true.
The MMFCA has been designed explicitly in combating Medicaid frauds. It also has
criminal provisions that specify certain liabilities of fines and imprisonment for: presenting a
false claim for payment to the state of Michigan, knowingly making ,misrepresentations or
misleading statements of material fact when applying for Medicaid benefits, entering into

2

FINANCIAL MANAGEMENT IN HEALTHCARE
agreements with other entities to defraud Medicaid using a false claim and offering, soliciting or
receivi...


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