Today& Sunday

J.W. respond with a min 100

Financial pressure or desperation individuals who are struggling financially may be more likely to engage in fraudulent activities to improve their situation. Also, a lack of ethics or moral values can contribute to fraudulent activity. When individuals do not have a strong sense of right and wrong, they may be more likely to engage in fraudulent behavior. The increasing use of technology and the internet has made it easier for individuals to commit fraud. Cybercriminals can use a variety of tactics, such as phishing scams and identity theft, to steal personal information and commit fraudulent activities. Individuals and organizations must be aware of and protect themselves against these risks.

One example of a fraudulent event in healthcare occurred in December 2015, when an Ohio cardiologist was sentenced to 20 years in federal prison. The cardiologist was found guilty of performing unnecessary catheterizations, tests, stent insertions, and coronary artery bypass surgeries to overbill Medicare and other insurers by $29 million. The legal ramifications of this fraudulent behavior were severe, with the cardiologist facing a lengthy prison sentence.

Based on the given example, it seems that the internal controls failed to address the fraudulent activities of the Ohio cardiologist. Even though the cardiologist was performing unnecessary procedures and overbilling Medicare and other insurers by $29 million, the internal controls were not strong enough to catch this fraudulent activity. This lack of oversight and failure to detect the fraudulent activity led to the cardiologist being able to continue his criminal activity for an extended period, resulting in his eventual sentencing to 20 years in federal prison. It is clear that stronger internal controls must be put in place to prevent such fraudulent activities from occurring.

R.C. respond min 100 words

· What are the primary factors that contribute to fraudulent activity?

One thing that can contribute to fraudulent activity is an opportunity if a healthcare organization has a weak infrastructure when it comes to malware and antivirus usually when you want to protect patient information you have to always look for ways and high security in order to protect them from any of their information being stolen.

  What happened in your chosen example and what could be the legal ramifications?

A hospital in Texas has been fined 21 million dollars for the misuse and overcharging, of Medicare and elderly patients. They have also been accused of charging for procedures that doctors have performed but really were out of the country when these procedures were performed.

· Which internal controls failed to address your chosen example?

· Explain.The internal control that failed to address my chosen example I believe is the organization as a whole including the billing department that allowed these charges to be made to Medicare.

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· What internal controls would you recommend that may help address your example in the future?

I would recommend that the risk management department audit every charge from the beginning of the investigation and ongoing into the future to ensure that this doesn't ever happen again. Also, all charges that have been flagged should be addressed in every huddle meeting with all administration.