Sample Essay on:
Medicare PPS Regulations and Regulatory Agencies

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Essay / Research Paper Abstract

A 5 page paper discussing Medicare’s attempts to find and halt abuses. The regulatory environment is such that many facilities employ workers for the sole purpose of reporting and filing claims, decreasing the facility’s ability to operate efficiently. The Health and Human Services Department instituted Operation Restore Trust in 1995, and the program has evolved into one that saves far more than it costs. Care providers can benefit from increased regulation and accountability in that they are forced to adopt sound business practices. Bibliography lists 6 sources.

Page Count:

5 pages (~225 words per page)

File: CC6_KSmediRegulat.rtf

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Unformatted sample text from the term paper:

in Columbus, Ohio conducted a "Senior Treatment Enrichment Program" to provide psychiatric services to older adults. The patients were mostly residents of local nursing homes and were transported to the hospital to take part in the program. On its surface, Park Medicals program appeared to be a beneficial one, but the center consistently billed Medicare and Medicaid for 20 therapy sessions each week for each participant, averaging nearly three sessions per patient daily if sessions were held seven days a week. Closer inspection revealed that the activities undertaken during these group therapy sessions were not psychiatric in their focus, but rather more for entertainment purposes. Psychiatric services are covered by Medicare and Medicaid; adult daycare is not (Montooth, 1996). The U.S. Attorneys office for the Southern District of Ohio conducted a two-year investigation of Park Medicals billing practices; the final outcome was that Park Medical agreed to pay $1.45 million to settle the investigation and escape criminal charges of massive Medicare and Medicaid fraud. This is one of the largest settlements reached in the many similar cases that have come under review. Aside from the fraud involved, the great pity is that Park Medical had hired a contractor, Quorum, to conduct the program. Shortly after agreeing to pay the large settlement, Park Medical immediately filed suit against Quorum in an effort to recover the funds. It appears that Quorum intended to defraud, but it was Park Medicals lack of any type of coordinated guidelines effort that allowed the abuse to go unnoticed for so long. Scrutiny of Payments For decades, jokes about the governments $200 hammers and $600 toilet seats were passed ...

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