Sound Financial, Ethical Practices In For-Profit And Non-Profit Healthcare Organizations

Reporting Practices and Ethics

HCS 405

Sound financial, ethical practices in for-profit and non-profit health care organizations are important because they increase the confidence that all stakeholders have in the organization. Health Care managers have to ensure that good ethical practices are employed while carrying out all the elements of health care finance management to ensure financial stability for the organization and preference from consumers and stockholders. There is much fraud and abuse in healthcare organizations that accounts for 3 to 15 percent of total health care expenditure according to the department of Health and Human Services and Department of Justice. This paper provides a summary of elements
In planning, the health care manager identifies the organizations objectives and sets up a program or step by step process through which to meet the organization’s objectives. In controlling, the manager evaluates the processes to see how the plans made are being followed. He or she will do these by comparing current performance with earlier performance to see if there are areas that need improvement. In organizing, the financial manager allocates resources to make sure that they are put into the most profitable use. In decision making, the manager selects the best course of action basing his or her decision on available information. When a finance manager incorporates good ethical practices while carrying out the elements of financial management, this will ensure organizational credibility. To limit fraud and abuse in health care organizations, they have to adhere to
The article gives examples of several health care organizations that have been found to be fraudulent, for example, a dermatologist who performed 3,086 medically unnecessary surgeries. The article also documents how Raritan Bay Medical Center agreed to pay 7.5 Million dollars for defrauding Medicare. The False Claims Act enacted by the federal government 1986 was intended to combat fraud and abuse in health care. The Health Insurance Portability and Accountability Act (/HIAA) passed in 1996 led to the establishment of Health Care Fraud and Abuse Control program (HCFAC) to further address fraud and abuse in health care. The increased surveillance has helped to reduce fraud and abuse cases by about 5%. According to the article common Types of fraud and abuse are misrepresentation of services with the wrong CPT codes, billing of services that were not rendered, billing for supplies not provided, falsification of records or providing medical services that are not necessary. According to the authors, fraud can be reduced by training and education, implementing computer assisted coding, increase regulation by the federal government or through the use of data modeling or mining. The significance of this example is to show the types of fraud, the various government agencies that work to prevent fraud and ways of combating