Read the Department of Justice story, “South Jersey Doctor Charged in Health Care Fraud Billing Scheme.” Then, write a 1–2 page report in which you:
- Summarize three quality issues in the case that resulted in fraudulent billing and coding.
- Describe three violations that were stated in the case, including how the violations applied based on regulations.
- Illustrate how this case could be used as a training tool for your organization. You may base your work on the Department of Health and Human Services Office of Inspector General (DHHS-OIG), the Center for Medicare and Medicaid Services (CMS), and the Department of Justice (DOJ) information on quality, fraudulent billing, and so on.
Requirements: 2 pages
Answer preview
Ortmann, 2018). According to the Inspector General, individuals and businesses who engage in fraud or abuse are barred from participating in all Federal healthcare programs, and CMPs are applied for specific infractions. As a result, the business can set compliance guidelines and assure continual training to keep the organization’s physicians and health care practitioners up to date. In addition, the case allows the organization to train employees on fraud, the consequences of its impact on individuals and health professionals, and the importance of maintaining integrity.
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