Instructions
In this assessment, you will continue as a member of the Chief Compliance Officer’s team. Recently, an incorrect billing practice known as upcoding has been discovered. Upcoding is a common area for fraud and abuse, and the recent incident has become an area of major focus for the Chief Compliance Officer.
The Chief Compliance Officer has tasked you with researching and making evidence-based recommendations about how to identify and address this incorrect billing practice. Your recommendations will be considered for possible inclusion in future policy and procedure content.
The Chief Compliance Officer has stressed with you the importance of incorporating evidence-based recommendations. This individual is specifically interested in the Office of the Inspector General’s position on upcoding, any relevant case precedents, and any available resources for health care organizations. You know from experience that the workplace brief will need to include substantiation of all facts and recommendations from authoritative sources. The team leader has asked you to cover all of the following headings in your brief:
Major Categories of Health Care Fraud and Abuse (2 pages)
Describe the major categories of health care fraud and abuse.
Be sure to include the billing practice known as upcoding.
Five Health Care Fraud and Abuse Laws (3 pages)
Provide a synopsis of five laws relating to health care fraud and abuse.
Include the rationale for why you selected the laws you did.
Upcoding and the Law (24 pages)
Explain in detail one law pertaining to upcoding.
Be sure to explain how the law specifically applies to upcoding.
Provide an actual example of upcoding.
Select your example from your suggested resources, from the research you conducted on the topic, or from your professional experience. If your example stems from your professional experience, please be sure to protect individual and organizational identities.
Identifying and Addressing Upcoding in Health Care (24 pages)
Propose a list of evidence-based recommendations to identify and address upcoding in the health care environment.
Be sure to consider in your recommendations what the Office of Inspector General has to say about identifying and addressing upcoding.
Tip: Visit these websites:
Centers for Medicare and Medicaid Services. (2021). Medicare fraud & abuse: Prevent, detect, report [PDF]. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Fraud-Abuse-MLN4649244.pdf
U.S. Department of Health & Human Services, Office of Inspector General. (n.d.). Compliance resources. https://oig.hhs.gov/compliance/
Additional Requirements
Written communication: Use the linked Identifying and Addressing Upcoding Template [DOCX]. Ensure your workplace brief is clear, succinct, well-organized, and generally free of errors in grammar, punctuation, and spelling.
Length: Approximately 810 double-spaced content pages in Times New Roman, 12-point font, including the reference page.
Title page: Develop a descriptive title of approximately 515 words. It should stir interest yet maintain professional decorum. Ensure that your title page conforms to the current APA format.
References: Include a minimum of 6 current (within the past 5 years), authoritative citations in current APA format. Include a separate reference page that also conforms to APA guidelines.
APA format: Use current APA style and formatting. Indent the first sentence of all new paragraphs.
Font: Times New Roman, 12-point.
Scoring guide: Review the scoring guide for this assessment so that you understand how your faculty member is going to evaluate your work.
Competencies Measured
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and scoring guide criteria:
Competency 1: Analyze health care laws and regulations from a local, state, and federal level.
Describe major categories of health care fraud and abuse, including the billing practice known as upcoding.
Competency 3: Assess the importance of continuous readiness in the health care organization.
Propose a list of evidence-based recommendations based on information from the Office of the Inspector General to identify and address upcoding within a health care organization.
Competency 4: Explain how governing body and regulatory agency standards exercise oversight authority within a health care organizational setting.
Provide a synopsis of five laws relating to health care fraud and abuse.
Explain one law that pertains to the practice of upcoding.
Competency 5: Communicate in a manner that is scholarly, professional, and respectful of the diversity, dignity, and integrity of others and is consistent with the expectations of health care professionals.
Develop a clear, concise, organized, and generally error-free workplace brief that provides evidence-based recommendations about how to identify and address the incorrect billing practice of upcoding.
Last Completed Projects
| topic title | academic level | Writer | delivered |
|---|