Fraud and Abuse

Other important legal considerations within health care fraud and abuse include the following laws and statutes:

Federal False Claims Act.
Anti-Kickback Statute.
Physician Self-Referral Law.
Criminal Health Care Fraud Statute.
Exclusion Statute.
Civil Monetary Penalties Law.

Don't use plagiarized sources. Get Your Custom Essay on
Fraud and Abuse
Just from $13/Page
Order Essay

Some of these involve related or overlapping areas.

This point in your health care administration career is an ideal time to deepen your knowledge and skills related to common fraud and abuse areas. You may wish to develop a short list of legal topics to assist in ongoing future monitoring workplace activities. It is important to include the associated authoritative governmental websites in your topic list.

In this assignment, you will assume the role of an early careerist in risk management and quality improvement at one of Vila Health’s community-based hospitals. Vila Health is a medium-sized system of health operating facilities in Minnesota and Wisconsin. You have been tasked with constructing a workplace brief for recommendations about identification of and interventions to address incorrect health care billing practices. In this case, upcoding is the incorrect billing practice that is the focus of the chief compliance officer. Your workplace brief will be used to influence future policy and procedure content for billing practices, including the incorrect practice of upcoding.

Instructions

Assume that you are a member of the chief compliance officer’s team in Vila Health. Recently, an incorrect billing practice known as upcoding has been discovered. Upcoding is a common area for fraud and abuse, and the recent incident has become a major area of focus for the chief compliance officer.

The chief compliance officer has tasked you with researching and making evidence-based recommendations about how to identify and address this incorrect billing practice. Your recommendations will be considered for possible inclusion in future policy and procedure content.

The chief compliance officer has stressed with you the importance of incorporating evidence-based recommendations. She is specifically interested in the Office of Inspector General’s position on upcoding, any relevant case precedents, and any available resources for health care organizations. You know from experience that the workplace brief will need to include substantiation of all facts and recommendations from authoritative sources. The team leader has asked you to cover all of the following headings in your brief.

Use the Identifying and Addressing Upcoding Template given in the resources to write your brief.

Major Categories of Health Care Fraud and Abuse

In one page:

Describe the major categories of health care fraud and abuse.
Be sure to include the billing practice known as upcoding.
Five Health Care Fraud and Abuse Laws

In two pages:

Provide a synopsis of five laws relating to health care fraud and abuse.
Include the rationale for why you selected the laws you did.
Upcoding and the Law

In one to two pages:

Explain in detail one law pertaining to upcoding.
Be sure to explain how the law specifically applies to upcoding.
Provide actual examples of upcoding.
Select your examples from the assigned readings, from research you conducted on the topic, or from your professional experience. If your examples stem from your professional experience, please be sure to protect individual and organizational identities.
Evidence-Based Recommendations to Address Upcoding

In one to two pages:

Propose a list of evidence-based recommendations to identify and address upcoding in the health care environment.
Be sure to consider in your recommendations what the Office of Inspector General has to say about identifying and addressing upcoding.

Tip: Review the following from the unit readings:

Avoiding Medicare Fraud and Abuse.
Compliance Resources.
Additional Requirements

Your assignment should meet the following requirements:

Written communication: Use the Identifying and Addressing Upcoding Template given in the resources. Ensure your workplace brief is clear, succinct, well organized, and free of errors in grammar, punctuation, and spelling.
Length: 5–7 single-spaced pages, including the reference page.
Font and font size: Times New Roman, 12 point.
Title page: Develop a descriptive title of 5–15 words. It should stir interest yet maintain professional decorum. Ensure that your title page conforms to current APA format.
References: Include a minimum of six current (within the past 5 years), authoritative citations in current APA format. Include a separate reference page that conforms to APA guidelines.

Review the Fraud and Abuse: Incorrect Billing Practices Scoring Guide so that you understand how your faculty member is going to evaluate your work. Submit your assignment as a Word document.

The Homework College
Calculate your paper price
Pages (550 words)
Approximate price: -

Why Work with Us

Top Quality and Well-Researched Papers

We ensure that our writers and editors work within the work guidelines and follow all paper instructions to the letter. When placing an order, you choose the academic field and expert level (high school, college, university, or professional). Our team then assigns your paper to a writer with a respective qualification or degree to ensure that you receive quality work.

Professional and Experienced Academic Writers

We employ professional writers with more than two years of experience in academic and business writing. Most of our writers and editors are native English speakers to ensure quality and professional work. We are confident that our team of professional writers can handle all types of business and academic writing work.

Free Unlimited Revisions

We provide a free revision service for all orders. If you feel that our writers missed something, you can request a revision of your paper at no additional cost. When we deliver your work, you have seven days to go through it and request a revision or modification if you are not satisfied. You can also contact our support team directly for any clarifications and queries on revision.

Prompt Delivery and 100% Money-Back-Guarantee

We ensure that all papers are delivered on time. In case we need more time to master your paper requirements and deliver quality work, we may contact you and discuss a deadline extension. If a deadline extension is not feasible, depending on the work and submission deadlines, we guarantee a 100% refund.

Original & Confidential

To ensure that we deliver plagiarism-free work, we use various writing and plagiarism checking tools. Our professional editors' team carefully goes through all work and references used in papers to ensure proper referencing and that original work has been done. We also guarantee confidentiality in all the services that we provide.

24/7 Customer Support

Our support team is available round the clock for any customer queries and communication. We guarantee 24/7 customer support and assistance. Feel free to contact us at any time of day for questions and follow-ups.

Try it now!

Calculate the price of your order

Total price:
$0.00

How it works?

Follow these simple steps to get your paper done

Place your order

Fill in the order form and provide all details of your assignment.

Proceed with the payment

Choose the payment system that suits you most.

Receive the final file

Once your paper is ready, we will email it to you.

Our Services

You do not have to spend sleepless nights worrying about your paper. We got you covered. We offer all kinds of writing services.

Essays

Essay Writing Service

Regardless of the type of academic paper you need and its urgency, we have writers on call ready to work on your paper. Feel free to choose the field, educational level, and type of paper you want, and we will deliver it at an affordable price. We are here for all your academic and business paper needs. With our round the clock service, we guarantee that you will receive your work on time.

Admissions

Admission Essays & Business Writing Help

Admission essays are written by students wishing to join a college, graduate school or university, as applications for enrollment. We guarantee quality admission essays and business papers with our professional writing and customer care support services.

Reviews

Editing Support

We have experienced academic writers and editors who are on standby to make all the necessary changed to your paper at your request. We ensure that your paper is polished and appropriately formatted (APA, Harvard, Chicago/Turabian, MLA formats) before it is delivered.

Reviews

Revision Support

We provide revision support, where you can request a revision of a delivered paper if you feel that it can be improved or repolished. Your paper is checked by an experienced writer or editor for revamping and improvement upon a revision request. Revision service is free, and you can use it as many times as you wish until you are satisfied with your paper.