Ethical Dilema

July 30, 1965, President Johnson signed into law Medicare and Medicaid. The unique payment methods created and apply by these two programs down led to several cases of health care fraud, more often involving Medicare. Medicare fraud can fall into triplet categories: phantom billing, patient billing, up coding or unbundling schemes (CMS). shade billing is when a aesculapian provider bills Medicare for procedures that were never manage or were completely supernumerary. When a Medicare beneficiary telephone exchanges their Medicare number and says they acquire services they actually did not receive in exchange for kickbacks is an example of patient billing. Finally, upcoding is when providers inflate patients bills and improperly code the procedures to make it seem that the patient was sicker than they actually were. The next paragraphs will discuss a recent example of Medicare fraud, methods the center of attention for Medicare and Medicaid Service are implementing in order to prevent in store(predicate) fraud cases, organizational policies that can prevent individuals from committing or go victim to fraud, and recommendations to prevent future incidents of Medicare fraud.
February 28, 2012, Dr. Jacques Roy and six others from North Texas were indicted in the largest healthcare fraud case in U.S. history (CBS DFW). Dr.



Roy and the others have been accused of cheating almost $380 million from Medicare and Medicaid between January 2006 and November 2011 (CBS DFW). He owned and operated Medistat Group Associates, an association of healthcare providers that provided fireside health certifications and performed home visits. Home health certifications are needed front to Medicare paying for these services. According to court documents, between January 2006 and November 2011, Medistat certified, more than 11,000 Medicare beneficiaries for home health services and had more patients than any other medical practice in the United States. Over $350 million of unnecessary services were billed to...If you want to get a good essay, order it on our website: Ordercustompaper.com



If you want to get a full essay, wisit our page: write my paper