The Concept of Health Care Fraud
Health care fraud is the imposition of plenty of unnecessary treatments. According to Pyrek (2011), fraud is determined as “deceit or breach of confidence perpetrated for profit or to gain some unfair or dishonest advantage” (p. 81). It is also should be noted that fraud associated with financial theft.
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The Importance of Prevention and Reporting Health Care Fraud
Health care value cannot be overestimated as it allows achieving goals such as natural population growth and the decline of morbidity that improves citizens’ welfare. Unfortunately, the prevalence of health care fraud hinders the realization of the above objectives that are priorities for the socio-economic policy of the United States. It defines the relevance of the topic. Additionally, fraud causes the increased cost of health care while its actual cost is not so high. With the above in mind, it is significant to report and prevent health care fraud.
Fraud Issues of the Case Scenario and Psychosocial and Physiological Complications
The case under analysis reveals the Patel case. It was stated that during his 25 years of practice as an interventional cardiologist, he falsified patients’ symptoms prescribing them unnecessary treatment, in particular, coronary procedures. The total number of indictments comprised 91 counts. Sometimes, it led to unfavorable consequences as in the case of a female patient, who wanted to donate her kidney to her son. However, Patel deployed a stent in her coronary artery leaving no chance for kidney donation. As a result, the boy continued to be on dialysis, and it caused physiological complications. Moreover, Patel was accused of billings falsification. Also, several witnesses confirmed Patel’s lack of patient care and safety resulting in psychosocial ramifications.
Ethical Issues Presented in the Case Study
Speaking of ethics, it is important to point out that health care fraud undermines citizens’ confidence in the medical community as it is considered that a health caregiver is a person called to help people providing the appropriate treatment promptly. Undoubtedly, some doctors work honestly for the benefit of society, but fraud cases create biased meanings about caregivers (Fabrikant, Kalb, Bucy, & Hopson, 2016). In its turn, it reduces the morality of the population.
The case also reflects the shortage of care of the patient. However, every caregiver including doctors, nurses, and other personnel should possess such qualities as compassion, kindness, sensitivity, and responsiveness as well as care and attention to the patient. The compliance of moral and ethical norms contains not only the performance of health caregivers’ duties but also imposes the responsibility for unprofessional actions including fraud.
Personal Point of View on Advocating by Patient Rights
If I were part of this Doctor’s team, I would proceed to advocate patients’ rights. First of all, I would report to the chief medical officer of those egregious cases. After that, I would suggest some measures to prevent possible cases. In the sphere of socio-economic relations, I would recommend conducting economic reforms aimed at curbing fraud using improving the system of remuneration of health care providers as well as enhancing their social status and prestige of the profession. From the technological perspective, I agree with Eramo (2011), who suggested implementing computer-assisted coding that would automatically review and validate the documentation of the health care provider preventing fraud.
Moreover, it seems rather useful to inform patients of their rights. As for ethical issues, I would recommend the introduction of anti-fraud training of caregivers that would develop ideas of social justice raising the level of legal culture of professionals along with the development of the responsible and highly moral behavior of health care providers. What is more, it is necessary to toughen the responsibility of persons found guilty of fraud and enlighten cases of fraud in public.
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Explanation of the Sentencing and Fine Appropriateness
Taking into account all the crimes Patel committed, the court “sentenced him to serve 120 months in federal prison and ordered him to pay a $175.000.00 fine” (Paterick, Paterick, & Fletcher, 2010, p. 243). In my opinion, punishment is the magnitude of this issue. I consider that ten years of jailing is enough to ponder over his behavior, mistakes, and the harm he did to his patients and repent. It might seem that the punishment is too strict as Patel is a 64 years old man. However, his actions caused plenty of damages including financial costs, physical, and psychological pains. In this regard, I believe that the sentence and fine are appropriate for this particular case.
In conclusion, it should be emphasized that the necessity of preventing fraud and abuse is obvious. Physicians, nurses, and medical institutions should take responsibility for their actions to ensure the principal mission of health care, namely, the welfare of the patient. It is important to operate honestly diagnosing only real diseases and providing only the required treatment. All in all, the case of Patel represents that every fraud would be punished.
Eramo, L. A. (2011). Stopping Fraud: Detecting and Preventing Fraud in the e-Health Era. Journal of AHIMA, 82(3), 28-30.
Fabrikant, R., Kalb, P. E., Bucy, P. H., & Hopson, M. D. (2016). Health Care Fraud: Enforcement and Compliance. New York: Law Journal Press.
Paterick, T. E., Paterick, Z. R., & Fletcher, G. F. (2010). A Case Study of Healthcare Fraud. The Journal of Medical Practice Management, 25(4), 243-244.
Pyrek, K. (2011). Healthcare Crime: Investigating Abuse, Fraud, and Homicide by Caregivers. Boca Raton, FL: CRC Press.