Question.1475 - Week 7: Discussion - Introduction to Coding and Reimbursement James Lewis 1212 unread replies.1818 replies. Week 7: Fraud is an act that represents a crime against payers or other health care programs (e.g., Medicare), or an attempt or conspiracy to commit those crimes. Abuse is a pattern of practice that is inconsistent with sound business, fiscal, or health service practices and which results in unnecessary costs to payers and government programs (e.g., Medicare), reimbursement for services not medically necessary, or failure to meet professionally recognized standards for health services. Discuss the importance of how you as a healthcare professional play a role in the prevention of fraud and abuse. What would you do if you believe fraud or abuse is taking place in your work environment. Discuss the potential benefit to you, your co-workers and your employer by reporting fraud or abuse as well as the potential detrement for not reporting fraud or abuse. Discussion Guidelines: Each week you will have a topic to answer and then respond to at least two classmates. This means, that if you follow the minimum posting requirements you will have one main substantive answer in each thread, and one response to at least two classmates. Altogether 3 posts, 2 of which will be on different days of the week. Be sure to check in if you have questions. Grading rubric for discussion posting per thread: Main post - 10 points (high quality) Response posts - 10 points (total of all responses) Post by Wednesday - 5 points
Answer Below:
Healthcare professionals must comprehend fraud and abuse and how to avoid them. Healthcare fraud is purposely defrauding insurers like Medicare for profit. Abuse takes place when healthcare standards are ignored and payers pay unneeded expenditures. Fraud and abuse may harm patients, payers, and the healthcare system(Sampson & Fried, 2021). Fraud and abuse prevention is essential for healthcare system integrity and patient safety. Healthcare personnel are crucial in discovering and reporting fraud and abuse. We can provide the best treatment and safeguard patients by remaining current on healthcare rules, policies, and ethics. Follow reporting procedures if you suspect workplace fraud or abuse. You may need to tell your supervisor, compliance officer, or the Office of the Inspector General(Sampson & Fried, 2021). Healthcare whistleblowers are protected from reprisal for disclosing fraud or abuse. Reporting fraud or abuse is ethical and may benefit you, your colleagues, and your company. Reporting wrongdoing promotes patient safety and efficient healthcare resource usage. This improves treatment and maintains healthcare system confidence. Reporting fraud or abuse may also save payers money, lowering healthcare costs. Not reporting fraud or abuse may have consequences(Sampson & Fried, 2021). By not reporting misbehavior, healthcare facilities risk patient suffering, payer losses, and reputation damage. Healthcare personnel may face legal and ethical implications for participating in fraud. By remaining quiet, healthcare workers risk losing their core principles of honesty, ethics, and patient-centered care. Finally, healthcare practitioners must avoid fraud and abuse. We can provide the best treatment and safeguard patients by being watchful, following ethics, and reporting questionable activity. Reporting fraud or abuse may protect patient safety, healthcare resources, and system integrity(Sampson & Fried, 2021). However, the risks of not reporting misbehavior emphasize the need to uphold healthcare ethics and law. Reporting fraud and abuse is a moral and professional commitment to protect patients and the healthcare system. References Sampson, C. J., & Fried, B. (2021). Human Resources in Healthcare: Managing for Success. Health Administration Press.More Articles From Strategic Management
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