Medicare Fraud and Abuse Risk

Assignment 1: Case Study – Medicare Fraud and Abuse Risk Management Plan

In this assignment, we examine the legal and ethical implications of fraud and abuse. Use the CSU-Global Library and the Internet to identify a real-world case of Medicare fraud and/or abuse. Write a 4-5 page Risk Management Plan for your healthcare facility using the readings, research, and your knowledge of health law and ethics to analyze this case.

Your report should address the following substantive requirements:

  • Description of what occurred, who was affected, and why.
  • Assess the case from the following perspectives:
    • Ethical—Identify the ethical principles involved in this situation from the perspective of all those involved.
    • Legal—What are the legal implications and what laws, or statutes were involved?
  • Develop appropriate policies and procedures to prevent this from occurring in the future.
  • Provide specific prevention mechanisms to deal with the case at hand.

Your report should meet the following structural requirements:

  • Be 4-5 pages in length, not including the cover or reference pages.
  • Be formatted according to the CSU-Global Guide to Writing and APA Requirements (Links to an external site.).
  • Provide support for your statements with in-text citations from a minimum of four (4) scholarly articles. Two (2) of these sources may be from the class readings, textbook, or lectures, but two (2) must be external. The CSU-Global Library is a good place to find these references.
  • Utilize the following headings to organize the content in your work:
    • Assessment,
    • Recommendations, and
    • Conclusion.
  • Assignment 2- Discussion Forum

    This discussion will look at a type of tort reform. Research a state which has instituted tort reform. Evaluate tort reform’s effectiveness or lack thereof. Debate whether or not national tort reform would be more effective.
    The initial post must be substantive (250-300 words); use 2 peer-reviewed, academic sources to support your statements with logic and argument; and cite all sources referenced.

    Required Textbook to use for both assignments:
    Pozgar, G. D. (2020). Legal and ethical issues for health professionals (5th ed.). Burlington, MA: Jones & Bartlett Publishers. ISBN-1: 9781284144185