Hint730 Legal Aspects and Compliance
WEEK 2 DISCUSSION
Using the Discussion Board Rubric listed below for the specific grading criteria, develop an initial response to the following:
The Office of the Inspector General, in conjunction with the Federal Bureau of Investigation is responsible for investigating healthcare fraud and abuse. One of the mechanisms for identifying and dealing with fraud is through the “Medicare Fraud Strick Force Teams”. These teams use data analytics to combat healthcare fraud, waste and abuse.
For this assignment, you are to evaluate one of the strike force actions taken in the last two years. You can find these cases at: Medicare Fraud Strike Force
- Scroll down on the page and select one of the strike force enforcement actions that have occurred in the past two years.
- Enter the action you selected on the Excel Sheet found here: Sign up Sheet. A sample entry is available so you know what to enter.
- A maximum of two students can review the same case. So if two students have selected the case you want to review, you must select a different case.
- Provide a brief summary of the case.
- Based on the report, what strategies could have been put into place to prevent this from occurring? Consider this from a data analytic perspective, an employee perspective, a patient perspective and a payer perspective. For example, how could a payer have noticed this activity was occurring? What procedures could be put into place to prevent employees from actively participating in the fraud? What data can be looked at to determine if improper billing was taking place? Can patients be educated to question their bills?
- Post your responses to #4 and #5 in your initial post. It is recommended that you do this in a word file and then copy and paste it into the DB.
- Response to two of your peers – What additional strategies would you give to them for their particular case?
Original response due by Day 3, 11:59pm ET. Reply to two of your peers by Day 7, 11:59pm ET.
To Post: Click open the discussion forum, click on Create a Thread, title your thread with your name and post your discussion response. You will not be able to see your peers’ posts until you post your own.
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