Module 7 Essay Review Questions
Read chapter 16 of your text. Answer the Discussion Questions on pages 551-552 (questions 1-11) in essay format.
Use a minimum of 2 scholarly sources, listed in APA format. See attached tutorial on APA format.
1. D iscuss the differences between fraud and abuse. D uring your discussion,provide examples of each and how health care managers might deal with them.
2. H ow has the history of health care compliance changed since its inception?(H int: L ook at the ways in which penalties have increased in various ways.) W hat do you think will be the key to getting control of the issue of fraud and abuse in the future?
3. C hoose one of the recent laws that have been enacted that are included in thechapter and discuss why it is or isn’t an effective stop-gap to health care fraud and abuse.
4. E MT AL A is a far-reaching act; explain several of its benefits and describehow it is effective at preventing fraud and abuse as opposed to detecting it.
5. D escribe your responsibilities as a health care manager as they apply to fraudand abuse. W hat if you were a unit manager? A department manager? A member of the executive division?
6. As you try to understand the fact that tens of billions of dollars are lost tofraud, is it the number that is troublesome or the fact that nobody can agree on an estimate? W hat is being done and can be done to reduce fraud and prevent it?
7. Y ou are the new compliance manager for a health care organization.D escribe the steps you will take to ensure that your compliance plan is legal and effective.
8. A physician and his colleague decide to set up a laboratory owned by adummy corporation in their wives’ names and begin to refer patients to this laboratory. W hat (if any) laws have they violated?
9. A psychiatrist bills for 10 hours of psychotherapy and medication checks for adeceased woman. H as he committed fraud or abuse? C an the deceased woman’s estate press charges if the bills were sent to Medicare, and not to the family?
10. An attorney sees a plastic surgeon and is so happy with her face-lift that shebegins to refer all her friends and family. At her 6-month follow-up, she says, “So, D oc, I’ve sent you all these patients, where’s my 30% cut of your fees?” W hat should the plastic surgeon do?
11. W hile working on your homework for this course and surfing the Internet to check out all the fascinating links, you realize the person who manages the branch of the new durable medical equipment company (D ME xcellence) where you work looks just like someone on the O IG Most W anted list. H e even has the same first name! And he has a wife who looks like the woman on the list with him! W hile you really need this new job to help pay your way through school, you have a sinking feeling all is not good at D ME xcellence.
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