Topic and Questions We Can Help You To Answer
Paper Instructions:

Healthcare Fraud... must be cited and current event, must follow all directions 

The Team Project includes two parts. In the first part, conduct your research on the project topic – healthcare fraud, following the project questions. In the second part, brief United States v. Greber, 760 F.2d 68 (3d Cir.1985) case, analyze the situation from the risk management point of view, and prepare a root cause analysis (RCA) and an action plan.

Part 1. Explain the concepts behind healthcare fraud. What are the advantages and disadvantages of using the criminal law to punish billing errors in a complex billing system? With respect to violations of false statements and anti-kickback statute, is it important whether a person knew conduct was wrongful? How did the corresponding amendment to the federal statue by the Patient Protection and Affordable Care Act impact the Ninth Circuit’s Hanlester Network v. Shalala decision? If doctors receive a fixed percentage of joint venture revenues, while this percentage does not depend on the number of referrals, is it legal under Medicare and Medicaid statute? How about under Stark? Compare the penalties (civil or criminal) and the knowledge requirement under Medicare statute and Stark. What could be potential ethical concerns in situations protected by safe harbors? Why doctors with some ‘ownership’ interest in Quest Diagnostics (a member of the S&P 500) may refer patient to Quest without a problem? Would there be a legal problem for a doctor with good intentions to waive a co-payment for an indigent patient?

Part 2. Summarize the facts and prepare a brief of United States v. Greber, 760 F.2d 68 (3d Cir.1985) using the IRAC method. Further, discuss the impact this Medicare fraud event had on internal and external stakeholders. Examine the legal implications related to the healthcare organization compliance, including a review of existing case law that may be applicable to this particular case scenario. Review any legal requirements associated with the case such as documentation and reporting requirements. Analyze the ethical implications associated with the case. Be sure not to confuse ethical and legal implications. Discuss the problem of a provider service arrangement where one of the purposes of the payment is to induce future referrals. Use the Joint Commission Framework for Conducting a Root Cause Analysis template to prepare a root cause analysis of an event in United States v. Greber case. Use the organization plan of action / risk reduction strategies in the template (p.10) to prepare an action plan for managing the risk associated with this event. As a result of assessing the situation and researching best practices, develop a comprehensive recommendation for the key decision makers of this healthcare organization addressing the business problems, opportunities, and a possible course of action.