Root Cause Analysis To Determine Why The Medicare Fraud Occurred

Read the news report “Maryland Health Care Provider Sentenced to 10 Years in Federal Prison for Health Care Fraud Resulting in Patient Deaths.”

Use the Five Whys to conduct a root cause analysis to determine why the Medicare fraud occurred and Timothy Emeigh’s participation in the case.

Write a 525- to 700-word paper that identifies and evaluates the root cause for Medicare fraud in this case.

Include the following:

1. List each of the Five Whys and your response.
2. Speculate as to why Mr. Emeigh participated in the scheme.
3. Explain what you might have done to prevent this from happening.

This is the link to the web site for this assignment

https://www.justice.gov/usao-md/pr/maryland-health-care-provider-sentenced-10-years-federal-prison-health-care-fraud

Cite 3 reputable references to support your assignment (e.g., trade or industry publications, government or agency websites, scholarly works, or other sources of similar quality).

Conduct a root cause analysis to determine why the Medicare fraud.

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Cause Analysis of Medicare Fraud

Fraud and Abuse Issues with Medicare

What area is more problematic to Medicare: fraud or abuse? Defend your choice. What is Medicare doing to alleviate this problem?

Medicare Abuse and Fraud Discussion essay assignment

As a health care manager, how do your operations decisions and legal and regulatory requirements impact each other? Provide examples. Include Reference

RESPONSE TO KATIE:….As a health care manager your operations decisions and legal and regulatory requirements impact each other greatly. You have to make decisions regarding your operations that align with the legal and regulatory requirements to avoid issues in the future that could be as large as breaking the law and could face severe penalties. Both teams should work together in tandem to ensure that all the regulations and legal requirements are being adhered to as well as ensuring that the facility runs smoothly and to the best of it’s ability.

GET THE SOLUTION TO THE PAPER. ORDER A CUSTOM-WRITTEN, PLAGIARISM-FREE PAPER Medicare Abuse and Fraud Discussion

As a health care manager operations decisions are important and you have to take everything into consideration, including budget, staffing, ordering needs, etc. this includes creating or helping to create policies and procedures. These policies and procedures must align with the regulatory compliance teams’ advice as to what ensures that legal requirements are being met. The staff must be properly trained on these policies and procedures. This ensures that both the patients and facility are protected from anything unlawful or against procedure occurring.

RESPOND TO PROFESSOR : Great response, Katie! You made an excellent point that operational decisions and legal and regulatory requirements impact each other immensely. Operational decisions must keep legal and regulatory requirements as a fundamental foundation which guides the direction of the operational processes. Without compliance being the center of focus, the risk is drastically increased for an organization. Fines and other penalties, including loss of enrollment with Medicare/Medicaid, can result if non-compliance is identified.

Katie and/or All—See the information from CMS regarding fraud and abuse. According to CMS, what is the difference between “fraud” and “abuse”?

Fraud and Abuse in Medicare Billing Discussion:

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