LEGAL ENFORCEMENT OF ETHICS IN HEALTHCARE: REGULATION OF ANTITRUST AND FRAUD

Assignment Overview

There are various forms of fraud that can be committed in a healthcare setting. Fraud not only impacts funding organizations, typically the Federal government and consequently, the taxpayers, but can also have an impact on the quality of care delivered to individuals. This case assignment examines healthcare fraud, the penalties that are associated with fraud cases, and then the role of Corporate Compliance Programs as a deterrent for fraud within healthcare organizations.

Case Assignment

New Orleans woman sentenced to prison for role in $3.2 million health care fraud and kickback scheme. Retrieved from: https://www.justice.gov/usao-edla/pr/new-orleans-woman-sentenced-prison-role-32-million-health-care-fraud-and-kickback

Sixteen individuals charged in $60 million Medicare fraud scheme. Retrieved from https://www.justice.gov/usao-ndtx/pr/sixteen-individuals-charged-60-million-medicare-fraud-scheme

Miami-Dade psychiatrist sentenced to prison for his participation in various fraud schemes. Retrieved from: https://www.justice.gov/usao-sdfl/pr/miami-dade-psychiatrist-sentenced-prison-his-participation-various-fraud-schemes

For this module’s Case, choose one of the cases of Medicare or Medicaid fraud listed above. Discuss the elements of the case, the decision that was reached by the court, identify the type(s) of fraud, and law(s) that were broken. Discuss and analyze the penalty for the perpetrator and whether the outcome was appropriate. Discuss how a Corporate Compliance Program can help minimize the risk of fraud for a healthcare organization.

You may research to find additional information on each case, as well as for general purposes for this assignment, but be sure to only use reliable sources.

Assignment Expectations

1. Conduct additional research to gather sufficient information to justify/support your report.
2. Limit your response to a maximum of 3 pages (title and reference page is not included in page number count).
3. Support your report with peer-reviewed articles, with at least 3-4 references. Use the following link for additional information on how to recognize peer-reviewed journals: http://www.angelo.edu/services/library/handouts/peerrev.php.
4. You may use the following source to assist in formatting your assignment: https://owl.english.purdue.edu/owl/resource/560/01/.
5. For additional information on reliability of sources, review the following source: https://nccih.nih.gov/health/webresources.
6. This assignment will be graded based on the content in the rubric.