HCM621-0804A-01 Ethics, Policy, and Law in Health Care Management - Phase 2 Discussion Board - Essay Example

Running head: Unethical behavior Unethical Behavior in Health Care Organizations Here Your and School Here Monday, October 20, 2008 AbstractThis author discusses unethical behavior in health care organizations. Is there a current trend for increased unethical behavior in health care organizations? Is there an explanation for such behavior?Ethics in Health Care OrganizationsFinding unethical behavior in health care organizations is not new. Consider one of the biggest scandals in the 20th century and how all other scandals are measured by that particular one, Watergate, part of the scandal included the burgling of a doctor’s office.

Every time you hear of a new scandal it is often labeled with the additive: gate, for example, “whitewatergate” or “fallagate”. (Safire, 1993) The Watergate scandal impacted our current privacy act and health care privacy laws. If you go to The False Claims Act Legal Center (http://www.taf.org) you will find out of the top 100 claims of violations and fines, over 50 of them are health care institutions. For example, July 2006, Tenet Healthcare had billing violations that include manipulation of outlier payments to Medicare, as well as kickbacks, upcoding, and bill padding.

June 2006, St. Barnabas Healthcare, filed false "outlier" Medicare payments (41%) which a hospital can claim if a procedure is particularly difficult or complex. January 2000, Fresenius Medical Care, the worlds largest provider of kidney dialysis products and services, was caught in a scam which involved fraudulent and fictitious blood testing, kickbacks to dialysis facilities to obtain blood testing contracts for LifeChem, and fraudulent claims submitted to Medicare for intradialytic parenteral nutrition.

(TAF, 2006)Different kinds of human nature are the driving force behind violations of ethics. Some people are motivated by weighing the risk of getting caught versus the benefit of the fraudulent act. Others might be acting in the interest of rivalry – will this act cause them to move ahead of the competition? A desire to succeed can sometimes cause shortcutting or sidestepping ethical policies. Some people follow the rules of ethics simply because they do not wish to pay the consequences. Many are motivated to keep ethical standards by their own sense of fairness and self-respect.

They self-police their own actions based on their moral code learned over time. And finally, some people simply do not know what the standards of ethics are about – never assume all people share the same education and ability to absorb external training. Since it is our business to provide ethical treatment and care for our customer – it’s in our own best interest to exceed minimum legal and regulatory standards to earn the respect and trust of our customers. One of the ways we can ensure that we do that is to learn and know the regulations that guide our missions.

We should also self regulate by following the guidelines of the Sarbanes-Oxley Act of 2002. (Sox Online, 2008). This is act that is designed to protect companies with transparency and accountability. The easiest way to do this is to design frequent training sessions to understand regulations, such as, HIPAA, the Mail and Wire Fraud Statute, Obstruction of a Federal Audit law, Federal Anti-kickback Statutes, False Statement Acts, False Claims Act and other integrity laws. (CMS, 2005)ConclusionAs long as we practice transparency and follow established ethics standards set by our management staff – we should have no problems with scandal.

It is important during our hiring process that we stress that ethics are enforced to the interviewees, for example, by giving them situational ethical questions and evaluate the answers as a preview. We can practice by periodically (monthly and annually) reviewing the applicable laws. We should offer open dialog with the staff and give opportunity for questions. By allowing them to participate in the establishment of ethical rules we give them ownership. We can, through awareness, habit, and observations become and maintain a reputation as a trusted provider.

ResourcesSafire, William (1993). Safires political dictionary. New York, NY: Oxford University Press, Inc.Top False Claims Act Cases by Award Amount (Jan 25, 2006) The False Claims Act Legal Center, Retrieved 10/19/2008, from http://www.taf.org/top100fca.htmWhat is Sarbanes-Oxley? (2006) SOX Online. Retrieved 10/18/2007, from http://www.sox-online.com/whatis.htmlLegislative Summaries. (2005) Centers for Medicare & Medicaid Services. Retrieved on 10/19/2008, from http://www.cms.hhs.gov/RelevantLaws/LS/list.

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