Problem:
The United States federal government has created numerous programs to combat fraud and abuse in the health care industry. The government now encourages health care facilities to have a corporate compliance program, a plan that reduces the chances that the facility will violate laws or regulations. A corporate compliance program is an organization-wide program comprising a code of conduct and written policies, internal monitoring and auditing standards, employee training, feedback mechanisms, and other features, all designed to prevent and detect violations of governmental laws, regulations, and policies. It is a system or method ensuring that employees understand and comply with laws that apply to what they do every day.
The case you select may involve fraud or abuse (such as defrauding the Medicare or Medicaid programs, the Stark self-referral law, anti-kickback statute, or price-fixing) or other criminal act, such as patient abuse, murder, or theft. Evaluate the laws that are involved in your case, and consider the ramifications of this criminal action on the individuals and organizations involved.
References:
Teitelbaum J., & Pozgar G. (2015). Law, ethics, and policy in healthcare administration (Custom ed.). Burlington: Jones & Bartlett Learning.
o Chapter: Government Ethics and the Law (pp. 236-254)
o Chapter: Physician Ethical and Legal Issues (pp. 299-323)
National Association of Medicaid Fraud Control Units. (n.d.). NAMFCU participating states.
United States House of Representatives. (n.d.). Find your representative.
U.S. Department of Health and Human Services. (n.d.). Compliance 101.