Ethics, Fraud and Abuse in Health Care - Essay Example

Introduction The role of ethics, fraud and abuses in healthcare industry has been widely acknowledged and such issues have become exceedingly controversial among the media and common public. Healthcare practices and interventions have been offered by different organizations having their own ideologies and interests. Previous studies and researches have emphasized the relation between ethical principles and patient’s rights. Malpractices and mismanagement in healthcare industry have often been highlighted and this emphasizes the need to maintain ethical codes and principles in various healthcare programs. Healthcare fraud and abuses have showed an increasing growth and therefore effective functioning of healthcare programs requires cooperation and mutual understanding between healthcare professionals and patients. Violation of patient’s right endorses miscellaneous effects in the social scenario. Ethical principles in healthcare programs can reduce healthcare fraud and abuses. This paper seeks to explore the ethical principles that govern health care practices and in doing so the paper throws light on the fraud and abuse that prevail in the health care industry. Ethical ideologies in healthcare industry Ethical problems are common in any field, but it is predominantly sensitive in the field of healthcare industry. The term ethics in healthcare has a wide range of meaning in medical field and its layers are many and varied. Ethical settings in healthcare program restrains numerous subjects like doctor’s paternalistic deceptions, rights of patients, refusal of life sustaining treatments, violation of patient’s confidentiality, biased free definitions of health, removal of viable organs of the patients who are brain dead, and conflict between doctors and their employers. Traditional healthcare ethics demonstrates various characteristics of professionals in healthcare industry such as welfare of patients, advanced medical knowledge, compassionate approach towards the patients, and reliable financial dealings. Examining healthcare programs and interventions one can understand that healthcare programs need to be motivated by some noble objectives than business profits. Generally healthcare ethics demonstrate moral values that are accepted and practiced by the society. Health care professionals and employers should offer their service, keeping all those ethical principles in their minds. Reliability and quality are essential features in the field of healthcare management and supervision. Professionals in healthcare industry should take the responsibility to ensure effective health services to the patients. This is very well suggested by Boyle when the author observes that “health care organizations are at differing stages of organizational development and complexity, especially with respect to the shift from medical to managerial professionalism” (Boyle, 2001, p. 11). Patients and his relatives have a right to fully engage in the decision making process regarding their ailments. However, unfortunately most of the hospitals and other healthcare institutions require putting in a signature or thumbing impression just for a formality. In case of major surgery an informed consent is essential and because of the absence of the consent many patients are likely to be victimized to malpractices. William Ruddick rightly comments that such “a physician who treats without such consent is not a patriarch, but a batterer” (Ruddick, 1998). Principles of beneficence, common good, distributive justice, patient’s right, human dignity, and toleration are the major ethical principles that enhance the effective flow of healthcare programs. Effects of fraud and abuse in Healthcare programs and interventions Healthcare fraud and abuse in healthcare has become a highly controversial issue and it affects not only legal or management practices, but also human life. The practitioner’s fraud and abuse may be aimed at financial benefits but one can never the severe consequences associated with health care fraud and abuses. Health care abuse is irresponsible health care service that goes alongside and is not in agreement with suitable business and medical practices ensuing in better repayment. Like abuse in healthcare, health care fraud is also a planned distortion, dishonesty, or intended act of treachery for getting better compensation. Professionals who practice in healthcare field should follow some moral values and principles in their work field. If they fail to follow these values they were subjected to healthcare fraud and abuse. In their collaborative effort entitled Safety and ethics in healthcare: a guide to getting it right, Bill Runciman et al remark: “Healthcare professionals and workers need to have a common understanding of the basic elements of quality, patient safety, and ethics” (Runciman, Merry & Walton, 2007, p. 240). Analyzing the current healthcare system, one can see many traces of abuses in health care such as prescription drug abuse, over billing, maintaining false health records, and lack of proper care and timely treatment. Rebecca S. Busch, in this respect, examines; “With the increasing issue of prescription abuse, recipients may request excessive drugs, or alter prescriptions, and even create counterfeit prescriptions for reimbursement in addition to access to medications that are not medically necessary”( Busch, 2007, p. 22). Health care fraud and abuse is a one of the nationalized dilemma that has a cause on each and every one of us either directly or indirectly. National estimates scheme that billions of dollars are mislaid to health care scheme and mistreatment on a yearly base. These fatalities show the way to augmented health care expenses and latent enlarged expenses for treatment. Healthcare fraud and abuse has reached its zenith and it is out of control that arises various practices in healthcare industry. It has been identified that “more than ever before, stakeholders in the healthcare industry face increased risk and potentially devastating consequences arising from fraud and abuse matters” (Healthcare Fraud and Abuse 2010). Current healthcare scenario is characterized by physical, sociological, psychological, emotional, neglect, financial or various other forms of fraud and abuse. Another healthcare fraud and abuse frequently arises in the case of diagnostic testing in which the physician acquainted with a health check is unnecessary but doing it nevertheless for the only reason of billing the indemnity organization and most of the cases patient failed to understand this type of abuses. In some days they committed falsifying diagnoses. It through deceitful concerning a patient’s analysis to validate costly health check, or surgeries and treatments, the scammer can be compensated for needless medical treatment. The poor people suffer this type of different problems in their health care. And they can also give healthcare fraud and abuse by billing each and every feature of a medical process as if it were a separate and different part of method. Preventive measures for fraud and abuse in healthcare Legal experts and healthcare officials have reported that absence of effective lows and public awareness caused unrestrained growth of fraud and abuses in healthcare industry. External interruptions such as politics, private organizations, racial groups and other socio-economic groups have also resulted healthcare abuse. So Service of a legal authority can prevent these kinds of external interference. Krause, Joan H explains; “Due to the unique nature of the laws used to pursue health care fraud, both public and private prosecutors also follow the money in choosing their targets and both may share in the spoils of a successful prosecution (Krause, 2010). Healthcare experts often comprise ethical considerations and in many cases, and their lawful responsibility towards the patient's wellbeing is often discarded. When there exist a clash between patient’s health and the expert’s payment, the patient’s health needs to be emphasized. Consequently, hospitals and health centers need characteristically to recognize patients with grave circumstances, whether or not those patients will be able to pay for the all treatment the medical experts should not advocate or recommend health care treatment that is not necessary for the patient's health, just to boost up their income or earnings. In some cases, unnecessary services do not have to be untrustworthy or serious to drop into this group, a professional suggests that a patient get a medicine or a surgical process that is not hurtful but is also not necessary but it is economically useful for the medical professional. Healthcare professionals should inform the patients about the possibility of treatment, duration, further treatment, expected benefits, and recovery period. The service of a monitoring agency can play a vital role in preventing healthcare fraud and abuse. Implementation of Anti-Fraud Programs is another significant approach in the process of preventing healthcare fraud and abuse. Detection, investigation, prevention, and sufficient reporting of cases are its major initiatives. Clinical trials and diagnosis programs can also contribute considerable role in preventing healthcare fraud and abuse. Conclusions To conclude, it can be stated that predominance to ethical principles are essential for the smooth functioning of various healthcare programs. Healthcare ethics should underline the relevance of socially accepted moral values and rules. Healthcare fraud and abuse have become a curse in the healthcare services and this adversely affect the healthcare industry in various forms like doctor’s paternalistic deceptions, refusal of treatments, fake bills in treatments and other types of healthcare services, false information about patient’s health condition and the purchasing of defective healthcare equipments for the treatment. Implementation of ethical principles and laws in healthcare industry can save patients from various types of healthcare fraud and abuses. The field of healthcare management has also equal importance in healthcare and management professionals in healthcare industry need to be made aware of the ethical codes and principles that are involved in their services. Thus, it is imperative that there is an effective monitoring system that takes into account the ethics, fraud and abuse involved in health care services whereby the health care industry focuses more on the patients' best medical welfare rather than making profits. Reference Boyle, P. (2001). Organizational ethics in health care: principles, cases, and practical solutions. Illustrated Edition: John Wiley and Sons. Busch, R. S. (2007). Healthcare fraud: auditing and detection guide. Illustrated Edition: John Wiley and Sons. Healthcare Fraud and Abuse. (2010). Holland & Knight LLP. Retrieved 10 Nov. 10 from: http://www.hklaw.com/id16048/mpgid4825/ Krause, J. H. (2010). Following the Money in Health Care Fraud: Reflections on a Modern-Day Yellow Brick Road. Retrieved 10 Nov. 10 from: http://www.allbusiness.com/government/government-bodies-offices/15078609-1.html Ruddick, W. (1998). Medical Ethics. Retrieved 10 Nov. 10 from: http://www.nyu.edu/gsas/dept/philo/faculty/ruddick/papers/medethics.html Runciman, B., Merry, A & Walton, M. (2007). Safety and ethics in healthcare: a guide to getting it right. Illustrated Edition: Ashgate Publishing, Ltd. . Read More