Attachment
PART 1
Throughout this course, you have examined occurrences of the types of health care noncompliance, fraud, and abuse that commonly take place in the context of the regulatory environment in which organizations must operate. To ensure the best chance of avoiding intentional and unintentional noncompliance, health care administrators should devise and adopt a risk management plan that identifies, assesses, and analyzes the risks and tolerances inherent in the organizations processes and operations.
One of the crucial aspects of a risk management plan involves strategies for actions that should be taken in the event of a violation or breach of any nature. These mitigating actions should be followed up with remediation aimed at finding the causes leading up to the incident. This is where root cause analysis comes into the picture.
Root cause analysis is a structured, retrospective analysis of events leading up to the noncompliant event. By developing an organization-wide policy for conducting root cause analyses that is adaptable to specific operations, a cause might be determined, and preventive actions and solutions developed.
In this assessment, you examine a case of fraud and try to determine why and how it happened.
from the United States Attorney's Office.
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 700- to 1,050-word analysis that identifies and evaluates the root cause for Medicare fraud in this case.
Include the following:
· Articulate the “Five Whys” for this case and provide an explanation for each.
· Speculate how and why Mr. Emeigh participated in the scheme.
· Explain what you, as an administrator, might have done to prevent this from happening.
· Recommend risk management strategies the organization can utilize to prevent this and similar types of events from occurring in the future.
Cite your sources according to APA guidelines.
Submit your report and article.
PART 2
Read "Thirteen Ways of Looking at Henrietta Lacks" from Perspectives in Biology and Medicine in the University Library .
Respond to the following in a minimum of 175 words:
· Select 2 points that the author makes that you may agree or disagree with and explain why. Relate your points to contemporary perspectives in health care qualitative oversight and support them with sources.
PART 3
Respond to classmates response with 50 words minimum each.
R1
Hi class the two point that the author made that stood out the most to me was when he stated the first one was when he said imagine that lack was asked for permission to use her cell was to be use in a research that might lead to a vaccine against pilo. I feel on this on all levels that it would of been a great thing what if they would of asked her. I feel the way patients rights were back than was so unfair it’s like who are you to just think it’s okay to do something like that. I know they were using it for the hood but how do they know mrs lack wanted that. Another point that stood out to me that was made was when he said today we have new regulations to protect patients privacy. I agree with this now they do. But do we really have privacy like she said like we are being recorded everyday of our lives. It’s like when do we really have time where we are free. He made some very good points in this article
R2
One point that stood out was when he spoke of Henrietta being so generous, she more than likely would have consented to use her cells. While reading the book the way Henrietta was portrayed, she definitely sounded like a woman who would do anything to help anyone. If she were knowing her cells would be used for so many positive outcomes, she would be happy that she helped people not be in pain. Another point that he spoke about that caught my attention was figuring out how each entity would get paid for the HeLa cells. Looking at the break down presented in the reading makes you think in more depth of the compensation. How do you determine who should be compensated if they did not give consent to use the cells either? The cells were spread out to so many places who began making great medical achievements would they get compensated as well for using the cells to produce a great product? The reading was great made you really go into detail of the case of Henrietta it left me in the middle of my ethical opinion, I did not think of even breaking down certain aspects.
Lantos, J. D. (2016). THIRTEEN WAYS OF LOOKING AT HENRIETTA LACKS. Perspectives in Biology and Medicine, 59(2), 228-233. https://www.proquest.com/scholarly-journals/thirteen-ways-looking-at-henrietta-lacks/docview/1876059666/se-2
R3
In this text, Lantos talks about indecipherable cause. In considering whether the lack of permission to utilize Henrietta’s cells along with the naming of the cells after her were unethical, I do believe that they did the right thing. Naming the cells “X-cells” to avoid having to validate and compensate the family would have been worse than the fact that permission was not granted in the first place. In my opinion, some form of acknowledgement is better than completely disregarding or pretending that the cells were random and unrelatable to a specific individual. I also agree with Lantos’ 5th point part of the pantomime. While medical professionals feel they must lead with caution when asking for donations, they have no way of knowing where that research will lead (Lantos, 2016). As we press through this course, I find myself finding more gray areas than before, and my ideals on things shifting. There are too many factors for it to always be clean cut. Qualitative oversight in health care addresses the concept of identifying the quality of something and not the quantity (McLennan, 2019). It is with this perspective that I understand the dilemma medical professionals find themselves in when doing research. I can become cumbersome trying to track so many donations and where they came from then to ensure they are acknowledged accordingly. It’s the same as thanking everyone to ensure no one is forgotten. Interestingly enough, I do understand and agree with these concepts.
R4
In Lantos' number 6, The Only Thing Moving, he present us with an interesting dichotomy - "We live in a world where each person's every living day [is] recorded in complete detail..." where "we have far less privacy than ever before." Yet, he states: "...we have new regulations in place to protect patient's privacy." What makes medical history more private than one's financial history, or an individual's voting history, or just about anything else? At this point, we afford a significant amount of energy to safeguarding patient privacy but less to everyday privacies - most of which can be bought an sold on the internet. The question is why? Any thoughts?