Pleases ee attached document

Topic 1:

Units of Measurement

The kitchen may be the one room in which most people are most aware of the different systems and units of measurements used in the house and around the world. In the United States (U.S.), milk is bought by the gallon, sugar by the pound, soda by the liter, and cereal by the ounce. After you unpack your groceries you store some in the freezer at 0°F or indulge in a snack by baking a treat in your preheated oven at 350°F. As you can see, you can encounter many different units of measure just in the kitchen.

The units used to measure today have been used throughout history, but does everyone use the same standard system of measurement? Currently the U.S., Liberia, and Burma are the only countries that do not use the System Internationale (SI), or more commonly known as the metric system. The units of measurement in the U.S. are based on the English Imperial system.

To start this week’s Discussion pick out a simple recipe that is given in the English Imperial system (select one from the internet if you do not have one of your own) and address the following questions:

1. Convert the ingredients in your recipe from its original imperial units into metric units. Post both the original and converted recipe in the same post so that your classmates and instructor can look at the differences. There is no need to post the preparation or cooking instructions—only the ingredients.

2. Was it difficult to make the conversion from one system of units to the other? Why, or why not?

3. Time to shift your focus to another system of measurements. Now, use an online mapping program to find out how far you will have to travel to get to one of Kaplan’s graduation ceremonies (in Chicago, IL or Miami, FL) from your hometown. Approximately how far in miles and in kilometers will you have to travel?

4. What if you wanted to know what the distance would be in smaller units? In the imperial system you could convert miles into yards and feet. Using SI units you could convert kilometers into meters and centimeters.

a. Convert the data from question 3 into the number of feet and meters you will have to travel.

b. Which system (Imperial or SI) did you find easier to calculate the smaller distances in? Why?

5. Humans have used different systems of measurement throughout history. Do some research on your own, and find a unit of measurement that you did not know about before and give a brief description of its history. Explain how to convert it into a unit of measurement that people would be familiar with today.

Topic 2:

· Discuss the outcome model of quality.

·

· Topic 3:

· Explain the concept of governmental regulation; delineate the impact it has on cost and quality of healthcare

Topic 4:

Starting on page 115 in your text, review the material on Title II and Healthcare Fraud and Abuse. Answer the following questions:

· What is a false claim?

·  Are mistakes and errors considered to be fraudulent behavior?

· What is the purpose of a Compliance Program?

· There are seven steps to a compliance program. Which step do you feel is most important to the process, and why?

PAGE 115 BELOW

 Title II—Preventing Health Care Fraud and Abuse, Administrative Simplification, and Medical Liability Reform.114115

FIGURE 5-4 HIPAA provisions.

    

HIPAA Title II—Preventing Health Care Fraud and Abuse

HIPAA defines  fraud  as “an intentional deception or misrepresentation that someone makes, knowing it is false, that could result in an unauthorized payment.” The attempt itself is considered fraud, regardless of whether it is successful.  Abuse  “involves actions that are inconsistent with accepted, sound medical, business, or fiscal practices. Abuse directly or indirectly results in unnecessary costs to the program through improper payments.” The difference between fraud and abuse ( Table 5-2 ) is the individual's intent; however, both have the same impact in that they steal valuable resources from the healthcare industry.

115116

   When a Medicare provider commits fraud, an investigation is conducted by the Department of Health and Human Services (DHHS) Office of the Inspector General (OIG). The OIG Office of Investigations prepares the case for referral to the Department of Justice for criminal and/or civil prosecution. A person found guilty of Medicare fraud faces criminal, civil, and/or administrative sanction penalties, including:

· • Civil penalties of $20,000 per false claim plus triple damages under the False Claims Act. (The provider pays an amount equal to three times the claim submitted, in addition to the civil penalties fine.)

· • Criminal fines and/or imprisonment of up to 10 years if convicted of the crime of healthcare fraud as outlined in HIPAA or, for violations of the Medicare/Medicaid Anti-Kickback Statute, imprisonment of up to 10 years and/or a criminal penalty fine of up to $100,000.

· • Administrative sanctions, including up to a $20,000 civil monetary penalty per line item on a false claim, assessments of up to triple the amount falsely claimed, and/or exclusion from participation in Medicare and state healthcare programs.