Hamoud Almutairi CJST March/11/16 Fraud A fraud is a wrong action, which is basically deprivation of the legal rights from an individual. Fraud is seen at various instances of life. There are a number of frauds that occur and every case has different rights being deprived from an individual. When frauds take place, some legal authority has to intervene and take the necessary action. The legal authority is granted with the power to decide the right that has been taken from the victim and identify the compensation to be given to the individual on behalf of the party, which has made the fraud. In this report, I will discuss some cases in which fraud caused some issues and deprivation of the basic legal rights of an individual thus resulting in …show more content…
Patients seek medical attention from the nursing homes. There nursing homes get a large amount of financial aid on behalf of the government. The financial assistance is given in order to ensure that all the necessary health care facilities are available at the nursing homes. There are few fraud cases that have seemed to occur in the nursing homes. One of the fraud cases that is becoming very common in nursing homes is that the patients are charged wrong amounts for the services that they acquire from the nursing home. The patient generally comes with some disease to seek medical attention. The nursing home raises fraud cases by advising unnecessary tests and procedures to be done on the patients. These tests or procedures may not be required for the patient. As the patient is limited in knowledge, the tests and procedures are done on the patient while charging the patient with a heavy amount of bill. (LLP, 2016) The nursing homes does not cater the specific problems that ha been raised by the patient rather they start to encounter on more details that are unnecessary and not even needed by the patient. The case is about a nursing home in Washington that charges heavy amounts to the patient for unnecessary treatments and procedures. (PEAR, …show more content…
The home health care facility is raised for providing the health facilities to the individuals at their homes. This health care facility does not have a very intensive control and supervision. Thus the most fraudulent cases occur in the home health care. The home health care providers are making large amounts of money and not being able to deliver qualitative services to the people. The health are providers are making easy money but not making an effort to improve the health of the individuals, rather they seemed to waste their time for the sake of retrieving money. The patients are not getting good health services and suffering at the hands of their health. They health care providers are having a very careless approach towards the patients. They do not diagnose the exact problem and carry out unnecessary treatments on the patients. Thus patient is not only charged with undue amount abut also suffers with more health problems. These health problems remain unaddressed thus becoming a cause of serious illness or sometimes it even becomes fatal. (Charles Piper,
Assisted Living Facilities abuse is a frequently occurring problem in our society (Hamilton). There are diverse categories of abuse that transpire in Assisted Living Facilities which are physical abuse, sexual abuse, emotional abuse, neglect, abandonment, and financial abuse. Samples of physical abuse would be hitting or beating the elders with an object or their hand, force feeding them or pulling their hands. Sexual abuse is the Assisted Living Facility employees having sexual acts with non-consenting patients. Emotional abuse is the employees saying things verbally to torment the patient. Neglect would be the employee does not take care of the patients such as providing hygiene. Abandonment occurs when leaving patients to fend for themselves. Financial abuse is when the patient’s family pays for the services that were not taken care of. “Elder abuse is fast becoming one of the uppermost law enforcement tasks of the next century, “said Paul Hodge who investigates crime against the elderly (Gonzalez). Since abuse occurs throughout assisted living facilities, state and federal governments should establish a type of punishment such as sending for employees to prison, ways to prevent abusing elderly’s is by inspecting employees ' criminal records, qualified staff, reporting injuries, having surveillance of the areas that do not affect patients privacy, promoting continuous family visits, and shortage of staffing.
As population ages, clinicians will care for an increasing number of elderly patients. Just as these patients may present unique and challenging medical dilemmas, so may they also present ethical ones. Ethical dilemmas are present in everyday practice. It provides a brief overview of the situations that may raise ethical concerns. Although, these are not the only ethical concerns that may arise during care of the elderly and are not unique to the population, they represent the most common scenarios that clinicians may encounter in their everyday course of practice. Ethics, according to (Mueller, Hook & Fleming, 2004), is the analysis and identification of the moral problems that arise in the care of patients. Ethical issues on geriatrics: a guide to clinicians (2004) reports that clinicians will care for an increasing number of elderly patients with challenging medical problems.
Deontology is an ethical theory concerned with duties and rights. The founder of deontological ethics was a German philosopher named Immanuel Kant. Kant’s deontological perspective implies people are sensitive to moral duties that require or prohibit certain behaviors, irrespective of the consequences (Tanner, Medin, & Iliev, 2008). The main focus of deontology is duty: deontology is derived from the Greek word deon, meaning duty. A duty is morally mandated action, for instance, the duty never to lie and always to keep your word. Based on Kant, even when individuals do not want to act on duty they are ethically obligated to do so (Rich, 2008).
This assignment will identify and evaluate the legal and ethical issues within the health and social care for elderly people with dementia and living in residential homes. It will address the difference between the legal and ethical issues and the impact it has on the person suffering from the disease, their family and the role that the professionals have in decision making for the individual’s wellbeing.
In the United States, healthcare fraud and abuse are significant factor associated with increasing health care costs. It is estimated that federal government spends billions of dollars on the health care cost (Edwards & DeHaven, 2009). Despite the seriousness of fraud and abuse offenses, increasing numbers of healthcare providers are seeking new and more profitable ways to build business relationships. These relationships include hospital mergers, hospital-physician joint ventures, and different types of hospital-affiliated physician networks to cover the rising cost of health care (Showalter, 2007, p 111-114). When these types of arrangements are made, legal issues surrounding the relationship often raise. There are five important Federal fraud and abuse laws that apply to the relationship and to physicians are the False Claims Act (FCA), the Anti-Kickback Statute (AKS), the Physician Self-Referral Law (Stark law), the Exclusion Authorities, and the Civil Monetary Penalties Law (CMPL) and (Office of Inspector General (OIG), 2010). Out of five most important laws that apply to the relationship and the physicians, we are going to focus on the Anti-Kickback Statute (AKS) and the Physician Self-Referral Law (Stark law).
Some federal statutes address fraud in government health care programs, and many of these laws vary considerably (Krause 2004). Some of these laws specifically target health care fraud. Example of the laws that the government direct at inappropriate health care activities includes the “Medicare and Medicaid Anti-Kickback Statute and Ethics in Patient Referrals Act (EPRA).”
The Omnibus Budget Reconciliation Act ,(OBRA), was established officially in 1987. This act was necessary as a result of abuse, neglect and poor quality care that was present in all nursing facilities. Children, veterans, mentally handicapped, and elderly were the prime populations in nursing institutions. In this essay, OBRA of '87, under the Nursing Home Care Act regarding the elderly, will be explored and addressed. The policy was established due to severe issues in elderly population facilities. Severe issues included: frequent use of restraints and psychotropic drugs, low quality care, and understaffed facilities. Standards of nursing home care and certain rights for for the elderly residents in the U.S. were enforced by Federal law. State and Federal government were required by law to scrutinize nursing homes and create higher quality standards by using a variety of sanctions. Some of the sanctions included: residents be handed their bill of rights manually, frequent one-on-one evaluations to be implemented, and a requirement of complete care plans and services. Overall, this bill was crucial with respect to a fast growing population that was filling up nursing facilities across America.
This scenario deals with an appeal by a estate administrator who sue a nursing home for "negligence, sexual assault and battery" due to failure of nursing personnel to protect their love one, but the nursing home is protected under the Medical Malpractice Act. Code §§ 8.01-581.1 through -581.20:1 (the Act)."
Providers must act in the best interest of the patient and their basic obligation is to do no harm and work for the public’s wellbeing. A physician shall always keep in mind the obligation of preserving human life. Providers must communicate full, accurate and unbiased information so patients can make informed decisions about their health care. As a result of their recommendations, providers are responsible for generating costs in health care but do not generate the need for those expenses. Every hospital has both an ethical as well as a legal responsibility to provide care, even if the care may be uncompensated.
Ethical principals are extremely important to understand in the healthcare field. Ethical responsibilities in any situation depend on the role of the healthcare worker and the nature of the decision being made. Healthcare administrators and professionals must make ethical decisions that can be an everyday or controversial situation. When making such decisions, it is imperative to consider the four major principles of ethics: autonomy, nonmaleficence, beneficence, and distributive. By using these four principles, ethical decisions can effectively be made. For the purpose of this paper, examined will be the example of the treatment of an uninsured homeless patient. Poor health care be a cause and a result of homelessness.
In this essay the author will rationalize the relevance of professional, ethical and legal regulations in the practice of nursing. The author will discuss and analyze the chosen scenario and critically review the action taken in the expense of the patient and the care workers. In addition, the author will also evaluates the strength and limitations of the scenario in a broader issue with reasonable judgement supported by theories and principles of ethical and legal standards.
With more health care records and information being stored electronically, there is more access to personal information that can be stolen and used for fraud purposes. In order to get a handle on this issue private citizens need to be further educated on what health care fraud is and how to prevent as well as report it. Health care professional are on the front lines of health care fraud and need to become proactive in being able to spot and report suspicious activity. With these actions taking place there can be a reduction in the amount of health care related fraud every
Federal and State laws require that nursing homes develop a plan of care and employ sufficient staffing to provide all the care listed on the care plan. Most corporate owned nursing homes today are not sufficiently staffed, and they can not provide all the care listed on the care plan. Consequently, residents are not taken to the toilet when necessary; they’re often left lying in urine and feces. They also develop painful and life-threatening decubitus ulcers, and are not fed properly, they’re not given sufficient fluids. They are also over-medicated or under-medicated, and dropped causing painful bruises and fractures, are ignored and not included in activities, are left in bed all day, call lights not answered. These are all forms of negligence, performed daily in nursing homes.
This week readings bring us overview of the issues we face in today’s healthcare such as “safe, effective, patient-centered, timely, efficient, and equitable” care (IOM, 2001, p 3). Safety and quality of care are the major factors which I think must be address to assure the best possible patients’ outcomes and to build culture of safety.
Fraud in a very general term is the crime of deceiving a person in order to get them to give up something in value, usually money and usually to the criminal himself or a group of criminals. This paper will be discussing cybercrime fraud, specifically cybercrime auto fraud, the type of scams associated with cybercrime auto fraud, the criminal profile of a cybercriminal fraud, law enforcement initiatives to combat this type of fraud and the penalties that go along with committing this type of fraud.