HSM420 Discussions Week 6

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HSM420 Discussions Week 6
Discuss fraud and abuse in healthcare. Provide at least three specific examples of fraudulent practices…

 

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HSM420 Discussions Week 6

HSM420 Discussions Week 6

All Students Posts 77 Pages

Fraud and Abuse – 44 Pages

Discuss fraud and abuse in healthcare. Provide at least three specific examples of fraudulent practices that have taken place in U.S. healthcare, and describe ways to prevent these in our modern healthcare environment….

Imagine how many other deceased patients there are that have been billed for services that they did not receive.  Many families will just ignore the bill and the provider will receive payment.  Monitoring fraud and abuse needs to be a priority.  Decreasing such acts will save the country millions.  What are some of the consequences that are given to providers who abuse the system or commit fraud?  What are Medicaid and Medicare agencies doing to prevent this type of fraud?

Does fraudulent behavior of employees stealing time contribute to growing healthcare expenditure?  Why or why not? In recent years, several companies have experienced a breach in their security and their patrons have been affected.  Within a healthcare facility, if a patient’s private information is stolen, who is responsible?  If it results in monetary damage such as credit cards being opened in the victim’s name, will the healthcare facility cover the damages?  Are there cases of providers serving jail time for fraud or abuse?  Are fraud and abuse different?  Are the penalties different for fraud than for abuse?…

Underwriting and Rating – 33 Pages

Explain the difference between underwriting and rating. What are the key elements that typically go into rate development formulas? I agree that underwriters must remain knowledgeable of all new laws.  This role involves continuous training.  What do you think is the most stressful about this job?  Do you think that it is difficult for the underwriter to keep emotion out of his/her decision?…

What can clients do if they do not agree with the underwriting findings? Do you think that lifestyle should be considered when determining the cost of coverage?  Within a workplace, should I have to pay the same amount as a smoker? With healthcare reform were changes made to the underwriting and rating process? Which health risk has the highest rating?  Which diagnosis can generate the highest premium? Does the Affordable Care Act look at health history to determine the rate the insured will be charged?

Are the premiums the same for everyone in a particular age group? If there are employees with pre existing conditions how does their rating affect others?  Should all employees have to pay for the choices of others?  Should I have to pay for a smoker?  Do you think that this type pricing determination is fair?  Is there a better way to rate patients? Some think that health status should not be a factor when determining rates.  I am not sure that I like the idea of health status not being a factor when determining rates.  Does this mean that non Affordable Healthcare plans will charge higher premiums to offset the plans within the Affordable Care Act?…