Read the news report “Maryland Health Care Provider Sentenced to 10 Years in Federal Prison for Health Care Fraud Resulting in Patient Deaths.”
Use the Five Whys to conduct a root cause analysis to determine why the Medicare fraud occurred and Timothy Emeigh’s participation in the case.
Write a 525- to 700-word paper that identifies and evaluates the root cause for Medicare fraud in this case.
Include the following:
- List each of the Five Whys and your response.
- Speculate as to why Mr. Emeigh participated in the scheme.
- Explain what you might have done to prevent this from happening.
Cite 3 reputable references to support your assignment (e.g., trade or industry publications, government or agency websites, scholarly works, or other sources of similar quality).
Format your assignment according to APA guidelines.
Expert Solution Preview
Introduction: The case of Medicare fraud resulting in patient deaths in Maryland calls for a root cause analysis through the Five Whys method. It is crucial to identify and evaluate the underlying reasons behind the crime. Also, it is essential to speculate the motive of Timothy Emeigh’s participation and discuss preventive measures to avoid such occurrences in the future.
List each of the Five Whys and your response:
1. Why did the healthcare provider commit Medicare fraud?
Response: The healthcare provider indulged in Medicare fraud because of the pressure to increase financial revenue and meet the organization’s targets.
2. Why was the healthcare provider’s revenue low?
Response: The healthcare provider’s revenue was low because of the high cost of operations, including staff salaries and purchasing of equipment.
3. Why did the healthcare provider not address the high cost of operations?
Response: The healthcare provider did not address the high cost of operations because of a lack of knowledge and expertise in financial planning and management.
4. Why did the healthcare provider not seek financial planning and management expertise?
Response: The healthcare provider did not seek financial planning and management expertise because of inadequate resources and financial constraints.
5. Why did the healthcare provider not seek assistance from government agencies?
Response: The healthcare provider did not seek assistance from government agencies because of fear of being subjected to regulatory actions and audits, which could expose their fraudulent practices.
Speculate as to why Mr. Emeigh participated in the scheme:
Mr. Emeigh might have participated in the fraudulent scheme because of the financial benefits promised to him. He might have also felt pressure to meet organizational targets and keep his job. Additionally, he might have believed that the fraudulent practices would not harm patients’ health and safety.
Explain what you might have done to prevent this from happening:
To prevent such occurrences, healthcare providers should establish internal controls and monitoring mechanisms to detect and prevent fraudulent practices. Appropriate training should also be provided to employees to understand the legal and ethical implications of Medicare fraud. Additionally, healthcare providers should seek financial management expertise to ensure sound financial planning and management. To avoid pressure to meet organizational targets, healthcare providers should set realistic and achievable targets. Finally, healthcare providers should seek regulatory and government agency assistance where necessary to address financial constraints and other operational challenges.
References:
1. The Department of Justice. (2021). Maryland Healthcare Provider Sentenced to 10 Years in Federal Prison for Health Care Fraud Resulting in Patient Deaths.
2. American Medical Association. (2021). Minimizing Medicare Fraud and Abuse.
3. Centers for Medicare & Medicaid Services. (2021). Medicare Fraud & Abuse: Prevention, Detection, and Reporting.
