If you were a manager in a health care organization and responsible for compliance, what would you do if you uncovered fraudulent billing in one of your departments?
Please discuss the following questions over the course of this week.
The Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) currently leads the fight against waste, fraud, and abuse by health care industry providers. Based on what you have learned to date in this course, if you were a manager in a health care organization and responsible for compliance, what would you do if you uncovered fraudulent billing in one of your departments? What would be your systematic action plan to resolve this issue?
You are managing a private multi-physicians group and two of the physicians want to change X for a new ambulatory surgical procedure while the two other physicians want to charge Y for the same procedure. They call you in to break the tie. However, when you question the four of them about how they decided on X or Y, they only shrug their shoulders, saying they chose X or Y, arbitrarily. As the manager, what information about pricing services would you share with the physicians? How would you help them make an informed decision about the pricing of this new procedure?
After you have read, Acute Care Hospital Inpatient Prospective Payment System from your readings, reflect on what you think is the single most important factor of Prospective Payment Systems and why? You will likely find significant diversity in one another’s responses. Reflect with one another on your choices and why you think your choices in PPSfactors may have differed.
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