Expert Answer :Fraud and Abuse in Healthcare


Solved by verified expert:Fraud is rampant in the healthcare industry. The size, scope, and complexity of the healthcare industry can attract individuals and organizations intending to defraud third-party payers, government agencies, and individuals. This fraud is perpetrated by those looking to access the billions of dollars available for legitimate medical care to patients needing services at all levels. By fraudulently billing for services that were not provided, kicking back monies to individuals, and carrying out other dishonest and unethical practices, individuals have stolen taxpayer funds and potentially prevented people in need from receiving necessary care. This multi-billion-dollar fraud has come under increasingly intense investigation, enforcement, and prosecution by a multitude of federal, state, and local agencies. Through their activities, billions are being recovered. According to the U.S. Department of Justice, more than $2.5 billion was collected in settlements and judgments from cases involving fraud and false claims in the healthcare industry during 2016. For the seventh consecutive year, healthcare fraud recoveries exceeded $2 billion.Healthcare leaders must be familiar with the agencies, regulations, statutes, and practice codes that impact the delivery of healthcare. Today’s healthcare leaders must understand the importance of establishing proactive compliance processes and be able to recognize and address potential situations at risk for fraud and abuse.By Day 7 of Week 2This week, assigned Presenters should post a PowerPoint presentation with a detailed notes section that contains the following:Incorporation and analysis of the Learning Resources from this 2-week unit, including identification of any apparent gaps in the literatureAn original research topic related to the week’s literature (the proposed research topic can be related to the general topic for the week or to gaps in the literature for the week, or it can be related to a specific reading for the week)Background information on the research topic, including identification of principal schools of thought, tendencies in the academic literature, or commonalities that define the academic scholarship regarding your topicEvaluation of the main concepts with a focus on their application to business/management practice and their impact on positive social changeA minimum of 10 peer-reviewed, scholarly new referencesNote: The presentation must be in APA format and must incorporate direct evidence of addressing the Learning Objectives from this 2-week unit. Each of the content slides must include detailed notes/paragraphs with appropriate citation of peer-reviewed, scholarly references.list of resources:Pozgar, G. D. (2016). Legal and ethical issues for health professionals (4th ed.). Burlington, MA: Jones & Bartlett Learning.
Chapter 2, “Contemporary Ethical Dilemmas” (pp. 66–120)Chapter 13, “Patient Abuse” (pp. 417–436)Allen, L. P. (2013). Fighting Medicare fraud under the False Claims Act. Health Law Litigation, 10(2), 2¬–6. Retrieved from…Note: You will access this article from the Walden Library databases.Beimers, T., Disenhaus, J., Kanner, S., Smith, C., Trilling, H., Wisor, R., Andonova, E., Furlow, A., & Thiess, D. (2017). OIG finalizes wide-ranging amendments to civil monetary penalties regulations and Anti-Kickback Statute safe harbors. Journal of Health Care Compliance, 19(1), 9–52. Retrieved from…Note: This article is 8 non-consecutive pages in length. You will access this article from the Walden Library databases.Holland, R. (2014). Of discounts and dangers: Swapping, discounting, and the Anti-Kickback Statute. Journal of Health Care Compliance, 16(1), 37–40. Retrieved from…Note: You will access this article from the Walden Library databases.Mathews, C. (2015). The hospital readmission reduction program: Fraud and abuse concerns. DePaul Journal of Health Care Law, 17(1), 31–46. Retrieved from You will access this article from the Walden Library databases.Pham, G. (2015). 2014 healthcare False Claims Act developments. Health Law Litigation, 12(2), 5–9. Retrieved from…Note: You will access this article from the Walden Library databases.Sidhu, A. S. (2015). The growing threat of qui tam litigation against healthcare providers. Health Law Litigation, 12(1), 12–19. Retrieved from…Note: You will access this article from the Walden Library databases.Westling, C. R., Walsh, T., & Nelson, W. A. (2017). Perceived ethics dilemmas among Pioneer accountable care organizations. Journal of Healthcare Management 62(1), 18–27. Retrieved from You will access this article from the Walden Library databases.


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information in the most logical way.
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slide, each element begins with an imperative
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spacing, placement, size, etc.
• Consider using the slide after the title
slide to summarize your presentation’s
points (like an abstract for a paper).
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Your slides can also contain entire paragraphs,
like this one does. Citation rules apply to
presentations just as they do to papers—when
using or referencing another author’s ideas,
you must cite that source. When incorporating
a citation in a slide, do so just as you would in a
traditional paper (Smith, 2010). According to
Jones (2007), presentations aren’t very different
from papers!
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Use APA style
rules to format
any tables and
figures in your
Figure 1. Bar graph showing useful information. From
“Utilizing bar graphs,” by A. Jones, 2011, Journal of
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• Remember to adhere to any assignment
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This template contains suggestions only.
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Always include a reference list at the end of your
presentation, just like you would in a paper.
Reference list entries take the same format they
would in a paper:
Jones, P. (2004). This great book. New York, NY: Publisher.
Smith, W., & Cat, D. (2010). How to make a good presentation
great. Presentations Quarterly, 45(4), 56-59.
Presentation  Format  
During  one  set  of  paired  weeks  in  this  course,  you  will  be  appointed  as  a  Presenter.  
When  you  are  the  Presenter,  you  will  prepare  an  individual  academic  presentation,  
much  like  a  poster  session.  Your  presentation  should  include  an  analysis  and  synthesis  
of  prior  research,  and  your  presentation  begins  the  interaction  with  your  colleagues.  You  
will  prepare  a  PowerPoint  presentation  of  7–10  slides  to  demonstrate  your  
understanding  of  the  research.    
Outline  for  Presentations  
The  following  PowerPoint  presentation  outline  is  suggested:  
Slide  1  
Slides  2–3  
Slides  4–6  
Slides  7–8  
Slides  9–10  
Contents  of  Slide  should  include:  
Title  Slide—Weeks  X–X/Week  Title/Presenter  Name    
An  incorporation  and  analysis  of  the  Required  Resources  from  this  pair  of  weeks,  
including  identification  of  an  original  research  topic  (related  to  the  general  topic  for  the  
week,  to  a  specific  reading  for  the  week,  or  to  apparent  gaps  in  the  literature)  
An  identification  of  principal  schools  of  thought,  tendencies  in  the  academic  literature,  
or  commonalities  that  define  the  academic  scholarship  regarding  your  topic  
An  evaluation  of  the  main  concepts  with  a  focus  on  their  application  to  
business/management  practice  and  their  impact  on  positive  social  change  
APA-­formatted  References  slide(s)  (to  include  a  minimum  of  10  peer-­reviewed,  
scholarly  new  references)  
Guidelines  for  Presentations  
You  must  use  APA  formatting  throughout  your  presentation  and  incorporate  direct  
evidence  of  addressing  the  Learning  Objectives  from  this  2-­week  unit.  Each  of  the  
content  slides  must  include  detailed  notes/paragraphs  in  the  Notes  section  with  
appropriate  citation  of  peer-­reviewed,  scholarly  references.  Please  refer  to  the  
Presentation  Rubric  for  specific  grading  elements  and  criteria.    
Note:  If  you  choose  to  include  graphics  of  any  kind  in  your  presentation,  be  prepared  to  
accommodate  participants  with  vision  loss.  Know  that  you  may  have  to  provide  a  written  
description  of  graphic  or  pictorial  material  for  a  fellow  student  who  is  visually  impaired.        
o   It  is  the  responsibility  of  any  participant  with  a  disability  that  limits  access  to  
the  PowerPoint  presentations  to  contact  the  Instructor  and/or  Disability  
Services  to  make  a  specific  request  regarding  this  assignment.  
©  2016  Laureate  Education,  Inc.  
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