Organizational Responsibility and Current Health Care Issues - Term Paper Example

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Running head: Health Sciences and Medicine Organizational Responsibility and Current Health Care Issues Insert Name Insert Grade Course Insert 30 May 3012 Background Healthcare fraud would be described as a deliberate misrepresentation of fact targeted to benefit the interest of someone at the expense of the public, unfairly, and usually perpetrated by avoiding protocol procedures in healthcare subsector or elsewhere hence unauthorized…
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Organizational Responsibility and Current Health Care Issues
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Download file to see previous pages The result of these unprofessional and criminal practices is an ailing health sector, poor health care standards, and reduced impact of government’s efforts in terms of provision of resources for the public health care services. In the United States, there have been a number of cases of fraud and abuse in the healthcare sub sector, but Federal authorities have unearthed and prosecuted many of these since early 1990’s; recovering substantial financial resources, as a result. Fraud can be a cause of significant losses in the public health sector denying the people efficient and most wanted medical services, which has repercussions of compromising the effective achievement of public health goals in a country. The practice can be curtailed through studying how it is originated and executed. This paper will explore the crime of healthcare fraud and abuse focusing on the effect of the organizational structure and governance, culture, and social responsibility and making recommendations on how these can be balanced to ensure the reduction of the vice or/and its complete elimination. The paper will also make evaluation of the sources that may be required to be allocated to avert future recurrence. In addition, it will assess the ethical issues that relate to the decision of allocating resources to combat it. Organizational Structure and Governance, Culture, and Social Responsibility and Health Care Fraud and Abuse a. A case of a health care news situation affecting a medical related organization A case in point of fraud and abuse of financial resources in a public hospital, for example, is one reported by the Kaiser Health News (KHN) where the Connecticut House passed a budget short by about $ 50 million in Medicaid programs because of medical fraud. It was alleged that doctors from Parkland Memorial Hospital and UT Southwestern medical Centre took advantage of the federal government’s health insurance programs. This was to the detriment of ageing and the underprivileged. Moreover, a lot of Medicare or Medicaid billing claims were falsely made with the intention to defraud the government medical fund through rehabilitation consultations. Medicaid costs had gradually risen to surpass costs of Medicare program for seniors or even private sector employer-sponsored plans in the last decade (KHN, 2012, p. 1). This raised more eyebrows and called for investigations after a federal judge spilled the beans through unsealing a whistle-blower lawsuit. b. Influence of the organizational structure and governance, culture and social responsibility on Fraud in Health care set up Fraud has the capability of destroying the reputation or image of any organization such as a hospital, insurance company, government agency or even a clinic for that matter as some of the institutions identified for this study. It can create fear, mistrust, insolvency and poor financial performance for an organization. Studies have shown that fraud contributes a minimum of 6% of any organization’s revenue or cash flow losses. The vice occurs during the normal hours of business operations and involves bending or/and breaking rules and regulations as well as going around internal control systems and financial reporting standards as an insider job, usually with the organization’s employees. Areas of operations, where fraud thrives, include ...Download file to see next pagesRead More
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