The concept of healthcare fraud assumes unlawful actions that an individual may carry out intentionally for a purpose to obtain benefits under a health care program to which this individual is not eligible (Rudman, Eberhardt III, Pierce, & Hart-Hester, 2009). The knowledge of fraud and abuse situations, as well as laws and policies a citizen is required to follow, is crucial for an individual not to commit an unlawful action unknowingly (Pelina, 2015).
This requirement refers to both the patients and the healthcare practitioners as either of these sides is able to violate the law. Pyrek (2011) explains that the cases of fraud and theft from the healthcare system of the United States are rather common, and the tendency persists due to the active financing of the healthcare system in the country. According to Pyrek (2011), the USA is the leader in the amount of money invested in healthcare. Minimizing the number of fraud and abuse in healthcare is vital for its improvement as the stolen costs never reach their intended destinations leaving some of the areas of healthcare lacking finances and resources and exposing the professionals and patients to multiple risks (Joudaki et al., 2016).
Fraud Issues and Complications
The case study by Paterick, Paterick, and Fletcher (2010), tells about Mehmood M. Patel, MD, a 64-year old professional, who worked in the field of interventional cardiology and who was charged for filing false reports and manipulating the data and symptoms of his patients in order to be able to push multiple unnecessary coronary procedures. Turning insignificant symptoms into a serious disease on paper, Patel was able to conduct thousands of procedures for which he was paid. This fraud resulted in the loss of capital and resources the doctor had been stealing from the healthcare system of the United States throughout twenty-five years of practice (Paterick et al., 2010).
In this case, psychosocial complications are represented by the doctor’s selfish treatment of his patients who entrusted him with their health and wellbeing and in return were intentionally misdiagnosed and charged for unnecessary procedures. Such stories destroy the trust of the public towards the medical professionals positioning the doctors and greedy and indifferent butchers lacking compassion. As for the physiological complications, in all the cases doctor Patel put his financial interest above the health of his patient’s health. In the situation with the female patient who came to Patel to be cleared for the kidney donation for her son, the doctor pushed an unnecessary procedure on the patient preventing her from kidney donation and endangering the life of her son.
Multiple medical experts and Patel’s coworkers involved in his case investigation noticed that the doctor failed to prioritize the needs of his patients and to search for solutions best for their wellbeing. As a medical professional, Patel was expected to fulfill his duties accordingly and focus on helping the patients. Instead, he managed to benefit from the health problems of the others and abuse his power, authority, and the trust of the patients and the healthcare system in order to improve his financial wellbeing. That way, Patel violated the ethical expectations laid on him as a medical professional.
Advocating by the Patients’ Rights
If I was a part of the team working with doctor Patel while he was practicing unnecessary coronary procedures, I would find it highly disturbing that expensive manipulations were pushed on the individuals who did not need them. Logically, I would assume that since the doctor was able to charge Medicare and private insurance companies for these procedures, he had them documented and proved necessary on the paper. That way, concerned for the patients and their health, I would contact the authorities of the organization and asked them to investigate some of the cases that looked suspicious in my opinion. I would not inform the patients about my concerns because they would lack proof and evidence. Also, I would confront the doctor in order to let him know that his practices received attention. That way, I would hope that he stops abusing his power and endangering more patients. In the case of the organization ignored my complaints preserving its reputation, I would move on to contacting higher authorities and organizations superior to a medical center or a hospital.
Fines and Sentence
For his abuse and fraud, Patel was sentenced to 120 in Federal prison and assigned a fine of 175 thousand dollars. In my opinion, this punishment is insufficient for a medical practitioner who had spent 25 years committing one fraud after another and endangering thousands of people.
Healthcare is one of the most intense career fields as the professionals there have no right to make mistakes. In case if mistakes occur, they result in harm to someone’s health and a lawsuit. Medical professionals are obliged by their career fields to be thorough, fair, precise, focused, fast, careful, and considerate. Entrusted with the health and wellbeing of the patients – the greatest value a person may have, doctors and nurses, have no right to abuse their power. As it happened in the case of Patel, malpractice of one doctor throws shade on all the others and leads to cuts in financing and the patients’ mistrust.
Joudaki, H., Rashidian, A., Minaei-Bidgoli, B., Mahmoodi, M., Geraili, B., Nasiri, M.,
& Arab, M. (2015). Improving Fraud and Abuse Detection in General Physician Claims: A Data Mining Study. International Journal of Health Policy and Management, 5(3), 165-172. Web.
Paterick, T. E., Paterick, Z. R., & Fletcher, G. F. (2010). A case study of healthcare fraud. Journal of Medical Practice Management, 25(4): 243-244.
Pelina, M. M. (2015). Health Care Fraud and Abuse. (Thesis). Web.
Pyrek, K. M. (2011). Investigating Abuse, Fraud, and Homicide by Caregivers. Boca Raton, FL: CRC Press.
Rudman, W. J., Eberhardt III, J. S., Pierce, W., & Hart-Hester, S. (2009). Healthcare Fraud and Abuse. Perspectives in Health Information Management, 6, 1-23