University of Maryland Health Care Fraud and Coordinated Care Paper
Theme 1:
According to Medicare, “The goal of coordinated care is to make sure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors.” Look at the internet and find an example of coordinated care. Identify the provider, explain the process and provide your opinion on whether it is an effective system and why.
Theme 2:
Health care fraud is a form of white collar crime. It involves filing illegitimate health care claims to turn an illicit profit. The 3 major laws that protect against healthcare fraud are the Anti-kickback statute, Stark, and the False Claims Act. From the readings and independent research, find one (1) specific real life legal case example of how kickback arrangements would violate the Stark Law. In addition, discuss with your colleagues how the kickback arrangements could violate trust between provider organizations and patients. From the readings and independent research, find one (1) specific real life legal case example of a breach of the False Claims Act by a health-related organization. In addition, discuss whether health care organizations are properly equipped to ensure compliance and minimize exposure risks. If not why not?
Read the background articles. This discussion requires research beyond the articles. See Discussion Expectations and Grading for rules on discussions.
Assigned reading materials:
- Medicare Fraud and Abuse: Prevention, Detention, & Reporting – https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/fraud_and_abuse.pdf
- Stark and AKS Chart-http://oig.hhs.gov/compliance/provider-compliance-training/files/StarkandAKSChartHandout508.pdf
- Breakdown of False Claims Act-(Control>>Click>>From Drop down Menu select Open in New Window or Copy/Paste into your URL) https://www.justice.gov/sites/default/files/civil/legacy/2011/04/22/C-FRAUDS_FCA_Primer.pdf
- The Stark Truth about the Stark law Part I http://www.aafp.org/fpm/2003/1100/p27.html
- Deficit Reduction Act-http://www.crowell.com/documents/docassocfktype_articles_919.pdf
- Brown, J. (2008). Develop a policy for amended records. Journal of Health Care compliance, January-February, 37- 38. [must use UMUC library]
- Mekel, M. (2012). The Health Care Quality Improvement Act of 1986 Meets the Era of Health Care Reform: Continuing Themes and Common Threads. Journal of Legal Medicine, (33), 106. [must use UMUC library]
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Theme 3:
Explain the differences between Research Methods and Research Design. Provide a description of two method examples and two examples of design types. When each is used? What is the process of choosing a correct research method and a correct research design?
