Fraud in Healthcare

Instructions: We want to believe that all health care workers are honest, and operate with integrity. Unfortunately, there are quite a few people and organizations that have ulterior motives, and seek to take advantage of the system. Research Medicare/Medicaid fraud and abuse cases to establish a foundation of knowledge for this assignment. Scenario: You have recently been hired as the manager of a home health agency. You are a new graduate, have been interviewing for months, and finally landed this position – which you love! As you review the files in your new office, you discover some alarming information, which leads you to believe the previous manager was intentionally submitting incorrect information on Medicare patients, in turn, receiving an overage of reimbursement for the agency. Explain the documentation you found that led you to believe fraud had occurred. In a concise paragraph, summarize how you should proceed (i.e. who should be informed?) What legal repercussions could your agency face if you report this information? Will your job be in jeopardy? Up to this point, you have examined the legal implications of this scenario. Now, consider the ethical obligation. If you commit to not continue the fraudulent practices of your predecessor, are you still obligated to report what you discovered? Address this question in approximately 500 words. Include the ethical theory that supports your response. A minimum of three references, in APA format, should be used for this assignment.

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