Assignment: Quality Issues & Violations in Healthcare Systems
In order to complete this case study, refer to this readings for policy information required to analyze and make recommendations on this case.
As a healthcare quality fraud analyst, you are responsible for identification of root causes and providing recommendations in an action plan to ensure compliance with federal and state quality policies.
Instructions
Read the Department of Justice story, "South Jersey Doctor Charged in Health Care Fraud Billing Scheme." Then, write a 1 to 2 pages report in which you:
o Summarize three quality issues in the case that resulted in fraudulent billing and coding.
o Describe three violations that were stated in the case, including how the violations applied based on regulations.
o Illustrate how this case could be used as a training tool for your organization. You may base your work on the Department of Health and Human Services Office of Inspector General (DHHS-OIG), the Center for Medicare and Medicaid Services (CMS), and the Department of Justice (DOJ) information on quality, fraudulent billing, and so on.
Format your assignment according to the following formatting requirements:
o The answer should be typed, using Times New Roman font (size 12), double spaced, with one-inch margins on all sides.
o The response also includes a cover page containing the title of the assignment, the student's name, the course title, and the date. The cover page is not included in the required page length.
o Also include a reference page. The Citations and references must follow APA format. The reference page is not included in the required page length.