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Wk 6 Individual Assignment: Root Cause Using
Assignment ContentRead Maryland Health Care Provider Sentenced to 10 years in Federal Prison for Health Care Fraud Resulting in Patient Deaths from the United States Attorney's Office.
Use the 5 Whys to conduct a root cause analysis to determine why the Medicare fraud occurred and Timothy Emeigh’s participation in the case.
Write a 525- to 700-word paper that identifies and evaluates the root cause for Medicare fraud in this case.
Include the following:
List each of the 5 Whys and your response.
Speculate as to why Mr. Emeigh participated in the scheme.
Explain what you might have done to prevent this from happening.Cite 3 reputable references to support your assignment (e.g., trade or industry publications, government or agency websites, scholarly works, or other sources of similar quality).
Format your assignment according to APA guidelines.
| Subject | Nursing | Pages | 5 | Style | APA |
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Answer
Root causes using Five Whys
Problem: Two patients died after obtaining the services of a Maryland Healthcare Provider.
Why: Why did the patients die?
The patients died because their congestive heart failure conditions were not accurately interpreted from the x-rays (The United States Department of Justice, 2016).
Why: Why were the patients’ X-rays not accurately interpreted?
The x-rays were not accurately interpreted because they were reviewed by non-physician Alpha Diagnostics employees such as Emeigh (The United States Department of Justice, 2016).
Why: Why did non-physician Alpha Diagnostics employees review the X-ray images?
Chikvashvili directed the non-physician employees to take part in the review of the X-ray images rather than the competent radiologists (The United States Department of Justice, 2016).
Why: Why did Emeigh agree to take part in the scheme?
I think Emeigh agreed to take part in the scheme because he was obtaining personal benefits from Chikvashvili, such as paid vacations, due to past participation in similar schemes, and he could not turn down the offer when contacted about the scheme.
Why: Why did Chikvashvili direct the non-physician Alpha Diagnostics employees to review the X-ray images?
Chikvashvili directed the non-competent employee to review the images because he was planning to defraud Medicare and he did not require people whom he could not trust to blow the whistle about the fraud plan.
Preventing Fraud
I could have prevented the fraud and the patient’s death in various ways. For instance, I could have relied on ethical principles focused on observing patient safety and advised Chikvashvili to seek the services of licensed radiologists to prevent errors which caused the death of the patients (Clarke & Nwosu, 2013). Observing accountability measures and reporting the planned fraud to the relevant authorities before it actually transpired to protect the patient’s interests would also be effective in this case (Honer, 2015).
References
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Clarke, A. & Nwosu, F. (2013). Fraud and Abuse in Healthcare Delivery Process: Southwest Region, United States. Journal of Functional Education, 3, 42-61. Honer, P. (2015). Improving the Processes and Safeguards for Fraud Detection and Prevention in Us Medicaid. Faculty of Electrical Engineering, Mathematics and Computer Science. Retrieved from https://essay.utwente.nl/69016/1/Hoener_MA_EEMCS.pdf The United States Department of Justice. (2016). Maryland Health Care Provider Sentenced to 10 Years in Federal Prison for Health Care Fraud Resulting in Patient Deaths. Retrieved from https://www.justice.gov/usao-md/pr/maryland-health-care-provider-sentenced-10-years-federal-prison-health-care-fraud#:~:text=Bredar%20sentenced%20the%20owner%20of,well%20as%20false%20statements%20and
Appendix
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