Using at least two scholarly sources and a biblical ingratiation, reply to the below post:
David Broussard
Fraud and Abuse
COLLAPSE
Fraud is an intentional act of deception, where a person deliberately provides false information or mispresents information that the person knows not to be true, in order to gain a benefit for that person. By contrast, abuse is an improper act that may be unintentional but is not consistent with standard medical or business practices, such as providing unnecessary medical tests or treatment or providing care that does not comply with professional standards. (Buchbinder et al., 2021) Fraud takes place in many industries. These industries range from medical to finance, and insurance to telecommunications. Pertaining to medical fraud, this area is generally divided into three types of fraud: provider, consumer, and insurer. (Ekin et al., 2018) For instance, total health care expenditures in the United States reached $3.2 trillion which corresponds to $9,990 per person in 2015 CMS. US federal agencies estimate that 3% to 12.7% of this spending is lost to fraud, waste and abuse. (Ekin et al., 2018)
One recent example of medical fraud deals with Dr. Salomon Melgen, an ophthalmologist practicing out of Florida. Salomon Melgen billed the government $190 million (148m; 174m) for services that were medically inappropriate between 2008 and 2013. 1 Patients’ diagnoses were written out by staff before they were seen, the most lucrative conditions were diagnosed in improbable numbers, and vision treatments were billed for prosthetic eyes, the jury found. (Dyer, 2017) His sentencing, at the time of this article, was predicted to be between 15 and 20 years in prison.
Healthcare managers are supposed to have knowledge of healthcare laws, insurance information, and many other areas of knowledge. Therefore, they are supposed to help prevent any fraud from taking place. As a manager, they are supposed to observe their employees and be on the lookout for anything going on that is wrong. If they suspect any fraud, they are to call it out and report it to appropriate authorities.
Proverbs 20:17 ESV Bread gained by deceit is sweet to a man, but afterward his mouth will be full of gravel.
Buchbinder, S. B., Shanks, N. H., & Kite, B. J. (2021). Introduction to health care management. Jones & Bartlett Learning.
Dyer, O. (2017). Medicares top billing doctor is convicted of medical fraud. British Medical Jounrnal, 357, j2188-j2188. https://doi.org/10.1136/bmj.j2188
Ekin, T., Ieva, F., Ruggeri, F., & Soyer, R. (2018). Statistical medical fraud assessment: Exposition to an emerging field: Statistical methods for medical fraud assessment. International Statistical Review, 86(3), 379-402. https://doi.org/10.1111/insr.12269
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