week 3 peer response
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week_3_peer_response.docxWEEK 3 PEER RESPONSE
· HMGT 335: Rules for discussion Comments on your peers: As Mentioned, unless stated otherwise - you need to make a contribution comment on two different peers. Saying " I found your comments interesting", or that is was very nice! isn't what the purpose is. Please feel free to support the thought with a reference, or disagree with or challenge the thinking. This is a "Critical Thinking" exercise! I have often found information to counter a statement that many take for granted. Feel free to challenge your classmates or enhance them. Doesn’t have to be a full response. But if you comment positively or negatively with some data, that is all that is needed (With a reference). This is what will lead to -------learning!!!!
Avoid using "I think" and "I feel" without any data..... That is just dinner table conversation! No title page needed. When addressing the person you are responding to don’t not write their name, use “ you, you’re”. You goal is to pretend like you are responding as if your me. ie. You forgot to mention how frogs cross the road. DO NOT SAY “ sally forgot to mention how frogs cross the road.”
No lengthy response needed. If the discussion has two parts respond to them both just like how the discussion is setup. Ie. Part 1 and part 2. No title page and do not double space.
Brenelys Hernandez posted Apr 1, 2016 3:58 PM
Part One: The last time I accessed health service I was seeking a dermatologist. The first thing I did was call and speak to my primary care doctor about my skin problems. I requested a referral and he asked me to come in and see him to see if it was something he could treat me for or if I indeed needed to seek a dermatologist. I then scheduled my appointment with my primary Doctor and my condition was something I needed to visit a dermatologist for. So I received my referral and saw a dermatologist. The reason why reached out to my primary care Doctor was so that I could be directed to the right provider that fit the service I needed and to also assure that this provider accepted my health insurance.
Part two:
In my opinion based on my readings, this Health Belief Model is still applicable today. The Health Belief Model is an archetypal pattern used to evaluate or influence an individual’s behavioral changes in regard to a particular health condition. The model suggests that the likelihood that an individual will take action concerning a health condition is determined by the person’s desire to take action and by the perceived benefits of the action weighed against the perceived costs of barriers. The model also evaluates how an individual estimates their susceptibility to a condition and the benefits of detection and treatment for that particular illness.
Sources:
Communication Pragmatics/Interactional View - Interpersonal Communication Context. (n.d.). Retrieved April 01, 2016, from http://www.uky.edu/~drlane/capstone/health/HBM.htm
University of Maryland University College. (2016). Week 3 Overview.
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· Week 3: Part 2 - Health Belief Model
Jasmine Cagado posted Mar 31, 2016 6:59 PM
The Health Belief Model includes individual perceptions, modifying factors, and the likelihood of action. With this, individual perception suggests that the motivation behind the search for health services rests on the questions: “what is the severity of the consumer’s condition?” and “how will the condition affect the patient’s life?” (University of Maryland University College, 2016). After these questions are answered, modifying factors (i.e. demographic, socioeconomic, personal knowledge, barriers, and marketing efforts) help to enhance or diminish the consumer’s desire to seek health service (University of Maryland University College, 2016). Finally, the likelihood of action will be determined as the consumer weighs the perceived benefits (pros) against the perceived barriers (cons).
In all, the Health Belief Model is still applicable today as this is the basic decision-making process. To explain, the basic decision-making process involves five steps to include: (1) stating the problem or goal; (2) gathering information to weigh your options; (3) considering the consequences; (4) making the decision; and (5) evaluating your decision (Rust, 2012). In relation to the basic decision-making process, the Health Belief Model states the problem through individual perceptions; gathers information through modifying factors; and the likelihood of action is when the consumer considers the consequences, then makes and analyzes the decision. As such, marketers can use the Health Belief Model to influence consumer’s decision process for health services by focusing on the impact of the health issue and benefits of treatment.
Reference
Rust, J. (2012). A 5-step decision-making process. Retrieved from http://www.mirasol.net/blog/five-step-decision-making/
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HMGT 372 General Rules for Discussions
· Comply with customary rules of online etiquette
· Do not repeat thoughts already posted by a classmate or your faculty member. Repetitive comments may be deleted and not count toward your participation grade.
· Do not get off topic
· Relate your posts to the course content
· No word count maximum or minimum, brevity is appreciated
· Do not upload a document in a discussion thread
· If referring to a link, please embed it in your post, don’t expect your classmates or faculty to copy/paste the link to see it
· The response doesn’t have to be super lenthy. No title page and do not double space.
· This Discussion has two parts
Jamie Harris posted Mar 31, 2016 6:29 PM
From a case that was settled in May of 2015, two prior employees of a medical equipment/supplies store filed a lawsuit, on the government's behalf, against one of the top executives of a company named Orbit. These two former employees proved that one of the executives knowingly instructed employees to forge and falsify medical supply prescriptions. The staff members were told to white-out information, forge doctors' signatures, and submit false claims to the government for payment.
Other than everyone knowing that this was illegal, morally and ethically, this was just unfathomable. How could one make the decision to forge doctors' prescriptions and how could one use the physically disabled to illegally profit in any way? There's no way that I would ever trust this company again. I would be skeptical about any other company that I later chose to do business with as well. I would question the doctors as well to see if they had any knowledge of this. It's just hard to believe that none of those claims were verified with the doctors' office and that the white-out was detected prior to the lawsuit.
I also saw a wheelchair scam on I Almost Got Away With It. The scammers would solicit the elderly and convince them to get electronic wheelchairs for later on in life because the wheelchairs would be more expensive later, according to the scammer. In essence, the wheelchair would sit for years, or until the purchaser needed to use it. This was all in order to illegally file claims with the government to pay for the most expensive, electronic wheelchair for a hefty payout to the company.
https://www.justice.gov/sites/default/files/civil/legacy/2011/04/22/C-FRAUDS_FCA_Primer.pdf
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· Anthony Campise posted Mar 31, 2016 10:18 PM
The Stark Law exists in order to prevent and deter as well as punish those who choose monetary gain over the best interests of their patients. For example, in 2011 the Midtown Imaging LLC radiology clinic in Florida reached a $3 million settlement with the Department of Justice for submitting false claims to Medicare during 2000 and 2008 as well as violating the Anti-Kickback statute. Due to a lack of transparency within the clinic's practice, patients were being referred to the clinic by physicians that had an inappropriate leasing and professional services agreement. Patients were referred to this clinic under the belief that the referring physician felt that this was in their best interest when really there was a financial motive. In this case the patients were not fully consulted and their right to choose and participate in their healthcare decisions was overridden by the greed of the clinic. The clinic prevented true informed consent by not disclosing their monetary agreements with the referring physicians and practices. Only a few days ago, a Michigan doctor had his license stripped for being involved in a scheme that billed Medicare for over $5 million worth of false claims. This physician received monetary kickbacks for writing unnecessary prescriptions, ordering unneeded tests, as well as scheduling appointments that were considered to be unwarranted. This physician certainly ignored his duty to inform his patients and let them make an educated decision with regards to their care. Not only did this doctor subject patients to pointless testing and procedures, but also risked complications due to unnecessary prescription drugs. These two cases demonstrate the need the United States has for the Stark Law and other laws aimed at preventing and punishing Medicare and Medicaid fraud and abuse. Fraud and abuse costs taxpayers millions of dollars annually as well as prevents those most in need of receiving the full benefits of our healthcare system.
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Week 3 Discussion 2
· False Claims Act--Billie Thorne
Billie Thorne posted Mar 31, 2016 8:53 PM
Case 1: In southeastern Kentucky a health care provider and several pharmacies were taking part in a fraudulent billing scam against the government. They did so my inflating the prices of prescription drugs more than allowed and more than they charged others who paid cash. The extra that was charged to the patients was then kicked back to the providers. The lawsuit in this case seeks monetary damages as well as ordering the hospital and the pharmacies to stop violating the law (Estep, 2016).
Case 2: Respironics Inc who is a sleep apnea mask maker has agreed to pay $34.8 million for providing kickbacks to suppliers of these devices. The company would provide medical equipment suppliers with call centers free of charge so long as the suppliers had their clients use Respironics masks. If the suppliers had their customers use a different company then the suppliers would have to pay a monthly fee. The fee was based on the number of Respironics non-users (Doctor, 2016).
I personally feel that all health care organizations are properly equipped to ensure compliance and to minimize exposure risk but there is always that “one bad apple” in the bunch that is looking to get a little extra money in their pockets. In the case of the False Claims Act it is hard to tell initially if someone is getting scammed so it is often gone un-noticed for a while and typically by then they have either stopped or they are so far into it that they slipped up somewhere or got carried away.
References
Doctor, R. M. (2016, March). Sleep Apnea Mask Maker Respironics To Pay $34.8 Million For Alleged Kickbacks.
Estep, B. (2016, March 30). Southeastern Kentucky health provider, pharmacies took part in fraud, lawsuit claims. Lexington.
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Jennifer Ashu posted Mar 31, 2016 1:19 AM
Case 1. I heard about this case while it was happening in court, this happened MD. A couple who made Medicaid fraud for about 5 year and got about $80million. The fraud was conducted through Global Health Care Services of the District, from my understanding that is where the lady Mrs. Bikundi who was 52 years old at the time, worked. She was convicted of four counts of health-care and Medicaid fraud and conspiracy. And her husband Mr. Bikundi, 63 at the time was convicted of two counts of fraud and conspiracy. For their punishment, they will be asked to forfeit $11 million in money that was taken form them, their luxury cars and their home. They will also be facing jail time and might be deported. Mrs. Bikundi should have never being able to even work as a healthcare provider or in a healthcare facility because her licenses had be revoked in Virginia. She changed her name when she got married and forged signatures on documents.
Case 2. This case is about a Guyanese, Parvattie Raghunandan, who only received five years of probation for fraud because she paid $85,000 back. She reported a fake income for her family for 10 years and by doing so she received benefits for Medicaid. Her family had enough money. They did not need Medicaid. Her lawyer argued she did not understand the paper work when she was filling it out seeing as English was not her first language. At least she did not go to jail. She had enough money to pay her way out of jail.
I think health care organizations are properly equipped to ensure compliance and minimize exposure to risk however this is mostly from the outsiders because people need some kind of information and password to get into systems. For some cases though the people who steal information are from the inside. For cases like that it is really hard to prevent anything because these people work with that information only a daily base so stealing the information is easy for them.
https://www.washingtonpost.com/local/public-safety/federal-jury-convicts-md-couple-in-80-million-dc-medicaid-fraud-case/2015/11/12/927dfa10-8988-11e5-be8b-1ae2e4f50f76_story.html
http://www.nydailynews.com/new-york/nyc-crime/woman-avoids-jail-huge-benefits-fraud-case-bronx-article-1.2404897
