HEALTHCARE FRAUD Health care fraud is a social and economic problem facing Americans today. In America, the scale of medical fraud is huge and affects many other sectors in the country. Scams could be as simple as patients claiming benefits they are not entitled to or suppliers charging Medicaid for non-existent services while others could be as fancy as the patients at the nursing homes for the old patients agree with pharmacists to supply their pills but bill Medicaid for much costlier ones. It is alleged that an unnamed clinic in New York wrote fake prescriptions for more than 5 million painkillers, which were consequently sold on the street for $30-90 each.
(Healthcare Fraud in America, 2014). No matter which culture is promoted by organization leaders, the strategy and environmental culture should be of consideration when forming the organizational culture. For a healthy corporate culture to flourish, the important values should be created and followed by everyone in the organization. The climate and culture of the clinic might have led to or facilitated unethical decision-making. Individuals who hold positions of leadership in the hospital ought to have created an ethical climate and moral tone that would have set the stage for and determines the outcome of individual decision making in the clinic.
A health organization must have a social responsibility in order to be widely accepted by the people and also have something that they do to increase coverage by the people. The clinic clearly lacked a social responsibility or lost focus of it because by increasing profit maximizing behavior it harmed the public’s interest in obtaining those services.
These painkillers would therefore not be available to all those who really needed them as others would buy just because it was a bargain. The organizational structure and governance of the clinic might have been ineffective and hence many corruption and embezzlement cases. The clinic might have been driven only for profit making purposes but in a world of scarce resources they could have found common ground in the need for effective governance. Lack of disclosure of information, oversight and accountability and lack of proper guidelines could have led to the fraudulent acts in the clinic.
(Clark, 2004) Trust critically matters in an organization. The clinic has to change rapidly to comply with regulatory standards set by the regulatory boards, the requests of all the stakeholders involved and the needs of the population they serve. Executives who might have been abusing powers in the clinic and making self-serving decisions like the example we have seen above, led to the unethical behavior in the clinic which in turn lead to the lack of focus on social responsibility. In future, the clinic administration should use cutting edge technology and sophisticated data analysis.
Another way to prevent the situation from reoccurring is to share data to make it easier for the clinic officials and law enforcement officials to identify criminals and prevent fraud on a system-wide basis. The ethical issue tied to this decision is that it is much better and cheaper to prevent fraud from happening than waiting for it to happen and then start doing the chase. In order to solve the issue and prevent it from reoccurring, I would involve strategic planning process so that policies, decision making processes, consultation, accountability, ethical standards, ongoing evaluation, and monitoring are in order to make sure that ethical practice by the workers of the clinic.
This would mean that any action is carried out for the sole purpose of making profit could lead to termination of employment of the person who does that. The ethic of care will be exercised at the clinic in order for the public’s health to be put first. All the employees and staff should be treated equally so that they do not feel the need to rebel against the clinic’s code of ethics.
I will ensure that the clinic participates in prevention and training programs or ethic programs to reduce the risks of unethical and illegal acts. There will be full disclosure of all material facts and arrangements of any proposed transaction to the head of the clinic. Compliance programs are not synonymous with ethics program yet organizations tend to use compliance programs as a way of addressing ethical issues. I will use compliance programs as a vehicle for protecting the clinic rather than as a means to instill critical ethnic values.
I will designate high-level personnel to oversee compliance, educate employees in the companys standards and procedures through publications and training. I will enforce standards through appropriate and consistent discipline and avoid delegating substantial discretionary authority to employees with a propensity for illegal conduct. I will also put up a system where all violations can be reported, and appropriate steps taken to improve the program. In conclusion, health care fraud arises when a person steals money or services, in turn makes these services unavailable for people who need them.
Fraud can involve medical professionals’ willingness to commit schemes putting patients’ health at risk and causing potential patient harm. Some of the practices include unnecessary and harmful surgeries, prescriptions for dangerous drugs and substandard care practices. Fraud is better prevented than cured, and so healthcare institution needs to create a fraud prevention program. Some of the critical features that need to be incorporated in the fraud prevention program include, getting an external auditor to conduct evaluation and even issue questionnaires to the employees.
An independent agent or party needs to perform an internal audit, and there should be benchmarks set for measuring best antifraud practices. References Butts, J. B. (n. d.). Ethics in Organizations and Leadership. Retrieved from www. jblearning. com Clark, A. E. (2004). Corporate Ethics and Governance in the Healthcare Marketplace. Seattle Journal for Social Justice, 205-210. Health Care Statistics. (2003-2015). Retrieved from Health Care Problems. org: www. healthcareproblems. org Healthcare Fraud in America. (2014, May 31). Retrieved from The Economist: www. economist. com Rudman, W. J., & Hart-Hester, W. P. (2009). Health Care Fraud and Abuse. Online Research Journal.