Healthcare Fraud Case Study

I will discuss why fraud occurs and discuss policies and actions at my hospital to prevent fraud, acting as a CEO of a hospital. No research is needed to tell anyone that the greed of money is the major reason why any sort of fraud occurs. In the healthcare industry, physicians, hospital administrators, and other healthcare professionals commit fraud by receiving kickbacks for unprovided goods and services. According to the Centers for Disease Control and Prevention (CDC), “health care fraud perpetrators steal billions of dollars each year from Federal and State governments, from American taxpayers, and some of our country’s most vulnerable citizens” (2013, para. 1). It is my job to ensure my hospital is in accordance with anti-fraud laws
Based on previous research, the Centers for Medicare & Medicaid Services (CMS) has a resource, Medicare Learning Network, which includes web-based training classes that offer continuing education credits. For example, physicians will be required to participate in the Avoiding Medicare Fraud & Abuse: A Roadmap for Physicians web-based training, which instructs physicians how to stay in compliance with fraud and abuse laws (Centers for Medicare & Medicaid Services, 2017). Additionally, all employees that are affected by anti-fraud laws will be required to take part in the Medicare Fraud & Abuse: Prevention, Detection, and Reporting web-based training, in which health care professionals learn fraud and abuse laws, who regulates these laws, and how to report fraud and abuse (2017). I will ensure that all employees are aware that detecting and reporting fraud and abuse are just as important as prevention. Moreover, employees are subject to reprimanding if they do not report suspicion or actually knowing of another employee engaging in
(n.d.). Health care fraud. Retrieved from https://www.cdc.gov/healthcommunication/toolstemplates/entertainmented/tips/healthcarefraud.html

Centers for Medicare & Medicaid Services. (2017). Medicare Learning Network (MLN) Fraud & Abuse Products. Retrieved from https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Fraud-Abuse-Products.pdf

Jefferson University Hospitals. (2014, January 20). Preventing fraud, waste, and abuse and the Federal False Claims Act (Policy Number: 122.11). Retrieved from