BHS 499 (Senior Capstone Project) Module 3 CBT Essay

BHS 499 (Senior Capstone Project) Module 3 CBT - turn out ExampleFraud as defined by the Merriam-Webster Dictionary of Law is any act, expression, omission, or cover song calculated to deceive an other to his or her disadvantage specifically a misrepresentation or filmdom with reference to some fact material to a transaction that is make with knowledge of its falsity or in reckless disregard of its truth... The HIPAA or wellness Insurance Portability and Accountability Act of 1996 defines it as a roughshod conspiracy or a violation to specific provisions indicated in the U.S. Code which pertains to conspiracy relating to a health bearing benefit program 18 U.S.C. x 24(a). Furthermore, fraud is basically considered as an act of misrepresentation or deception designed to acquire something of value held by some other and the most mutual forms of fraud among nurses documented by CNO include falsifying a record collecting pay under(a) false pretenses misappropriating property or money through deceptive means andproviding false information to ones employer (Quality Practice, 2003 p 1). Below outlines the managerial, legal, ethical and financial implications brought about by fraudulent and financial abuse in the health care industry.The unnecessary patient treatments that are being ordered, limits the patients coverage which whitethorn be subsequently met untimely later, patients may not be able to expend co-payments for gratuitous visits. In addition, false diagnoses for the purpose of up-coding may affect the patients ability to obtain maintain insurance coverage since the information is available primarily to other potential insurers (Busch, 2007).According the National Health Care Anti-Fraud Association, around $56.7 to $170 billion is the estimated loss annually (Department of Health and Human Services, 2005). Centers for Medicaid & Medicare (2006) expressed that the dollars lost to reimbursement of Medicare and Medicaid as well as intentional improper b illing could consecrate been used to fund the health insurance of low-income persons if they were not acquired or end up in the pockets of the unscrupulous health care suppliers and providers. The Provision 3.5 under the Code of Ethics calls upon that all nurses needs to take entrance action about any instances of unethical, incompetent, illegal or impaired practice by members of the health care team or any action on the side of others by the health care remains which places the best interest of the patient (American Nurses Association, 2001). Fletcher, Sorrell, and Silva (1998) stupefy point out that nurses are frequently called upon to shake up sacrifices, in their personal as well as professional, ones they adhere strictly to Nurses Code of Ethics. This code 3requires nurses accountability as professionals however fails to acknowledge that the reality is that in the health care system, many nurses have limited power within. Job security for fraud investigators and auditors r emains strong. Over the years, it continues to attract the nurses who are ethically challenged. Health care fraud is oftentimes buried within the functions in critical business. In 2006, initiatives were made to implement the development of health information technology infrastructure, in order to improve the