Reference no: EM133676068

Question

1. Comment on the student's interpretations of fraud and abuse. Do they describe a valid example of each of these terms as they relate to healthcare? How so?

2. Discuss any additional legal obligations or responsibilities to which a healthcare manager or administrator should adhere in response to allegations of fraud and abuse.

3. Choose one of the student's examples of fraud or Discuss how you would suggest responding to this scenario if you were a healthcare administrator, manager, or member at the executive level.

Include your rationale for acting accordingly. The two types of unethical behaviors are healthcare fraud and healthcare fraud, which are commonly linked. Healthcare fraud implies executing a deliberate deception or misrepresentation of known or untrustworthy information. On the other hand, the purpose of the deception is to receive illicit benefits. Cases like overcharged services that were not rendered, fictitious diagnoses, and adjustments in billing sheets (for the higher reimbursement ratio) are just some of the instances to be governed. Abuse, however, shows practices that may or may not be fake and are inconsistent with sound financial, business, or medical practices. This consequently creates extra costs for healthcare programs by using unnecessary resources excessively or paying more than warranted for services or supplies. Being excessive by doing more tests for no clinical reasons could be an instance of misuse. Healthcare administrators and managers face.