Governance AND FRAUD IN HEALTH CARE ORGANIZATIONS

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GOVERNANCE AND FRAUD IN HEALTH CARE ORGANIZATIONS - LEGAL AND ETHICAL RESPONSIBILITIES (12.5 POINTS)

INSTRUCTIONS

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 are required.

Outline: Must use the underlined headings from the outline below in your paper and the paper must be in narrative form not outline or bullet format. 5% penalty 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.

  • 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.

  • 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

  • Reference List [APA Format]

The paper must be:

  • 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.
  • 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

Answer posted please confirm.Kindly go through the work and let me know in case of any question,problem or clarification.If the answer is okay,looking forward to work with you again.Thank you

Topic: Governance and Fraud in Healthcare Organizations: The False Claims Act


Introduction



Question Analysis



References


Running Head: GOVERNANCE AND FRAUD IN HEALTHCARE ORGANIZATIONS

Governance and Fraud in Healthcare Organizations: The False Claims Act
Name
Institutional Affiliation

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GOVERNANCE AND FRAUD IN HEALTHCARE ORGANIZATIONS

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Governance and Fraud in Healthcare Organizations: The False Claims Act
Brief Overview
Healthcare fraud is a problem that has faced the healthcare organizations since time
immemorial. Billions of dollars are lost annually due to the problem of a false claim in the
healthcare industry. Although the Department of Justice has addressed the problem by
implementing laws that mitigate it, false claims and fraudulent claims are still a problem.
Various states have also passed their modified versions of the federal False Claims Act.
Moreover, private individuals benefit from the False Claims Act since it allows them to file
actions against fraudulent defendants. The following discussion will focus primarily on the
federal False Claims Act and the enacted False Claims Act in the state of New York.
1. Name of the Law(s)
The federal False Claims Act is an American state law that is commonly referred to as the
Lincoln law. In 1863, under President Abraham Lincoln, the False Claims Act was passed by
Congress. It is under section 31 of the United States laws code 3729 which outlines all the details
contained in the Act (Sawyer, 2011). The Act is a tool used by the federal government, and a
total of 32 states form falsely billing the government, overstating the amount payable by the
government in the claim and understating the obligation to the government. This law imposes
liability on persons or companies that seek to defraud government programs such as Medicaid
among others.
Under the healthcare system, the government disburses funds that help programs related
to the healthcare organization to run smoothly. Since the organizations have to account for the
funds, the False Claims Act enables them to obtain detailed information on the claimant and

GOVERNANCE AND FRAUD IN HEALTHCARE ORGANIZATIONS

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establish their authenticity. Some of the...


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