Home Care Hospice Fraud
Home Care Hospice Nursing Fraud Case Study Example
Five nurses from home care hospice: Patricia McGill from Philadelphia, who served as the director; Natalya Shvets, aged 42 years from Southampton; Giorgi Oqroshidze, aged 36 years from Philadelphia, Yevgeniya Goltman, aged 42 years from Newton and Alexsandr Koptyakov, aged 39 years from Bensalem got arrested. They were employed between 2005 and 2008 and are accused of multi-dollar fraud, approximately $9.32 million. Matthew Kolodesh, a co-owner, was charged with giving Patricia access to hospice (Barger, 2016). The hospice was a for-profit at 1810 and 2801 grand avenues in Philadelphia, and it provided services at hospitals, nursing homes, and private residences.
The case was investigated by the federal bureau of investigation and human services office of inspector general and said that McGill permitted nurses to forge documents to support patients who were not eligible for the hospital and more costly than what they provided to the patients. Matthew and Patricia gave authority while the other nurses provided false documents for patients indicating that they offered services. According to the audit review, Patricia assisted Matthew in reviewing patient charts and authorizing the alteration of charts (Barger, 2016). The hospice was notified by the government to repay $2,625,047, but instead, Matthew and Patricia ordered staff to review patient’s files, which lead to a mass discharging of patients, about 128 patients. Some patients shifted to a hospice owned by Matthew, and approximately 26 patients who were discharged were re-admitted in the hospice with Patricia’s knowledge. They are all found guilty and should pay fine, a special assessment, and be imprisoned. The discussion below will shed light on measures to reduce or prevent fraud in health care facilities.
Measures to Reduce or Prevent Fraud in Health Care Facilities
Encourage Transparency and Accountability
Being the hospice administrator, I would ensure proper guidelines for transparency and accountability in the hospice. The policies would include payment methods and procedures on incentives and informal payments (Gaitonde et al., 2016). Also, I would establish an agency to inspect and enforce struggles against overbilling, which may reduce overbilling. I will introduce well-known channels of punishment if one is found guilty of fraud. Introducing a law to govern gifts and tips from pharmaceutical companies to the staff would help regulate corruption in the hospice.
Engage External Agencies
Getting to know that the nurses were involved in corruption before the government conducted an audit, I would investigate facts about the case. As Matthew and Patricia are the leading players, I would report them to the anti-corruption organization (Gaitonde et al.,2016). The remaining four nurses should face the senate committee to face their punishment according to the guidelines. Matthew and Patricia should be sucked and cleared by the hospice.
Implement Internal Controls Measures
To prevent more fraud activities in the hospice, I would increase the efforts to maintain a free fraud zone. This means more guidelines and extra keenness to implement the policies. Also, efforts to investigate and punish staff found with fraud would be increased (Gaitonde et al.,2016). Putting more emphasis on patients giving tips and gifts to the team would help reduce fraud activities in the hospice. Also, more guidelines to regulate informal payments would be an essential aspect of the hospice.
Conclusion
Evidence is scarce on how best to reduce fraud in health care, but there are promising intrusions which include the detection and punishment of those found guilty. Separate agencies also can reinforce maintaining transparent and accountable systems in many hospitals. Proper guidelines should be put in place to govern the activities in the institution.
References
Barger, J. (2016). Life, Death, and Medicare Fraud: The Corruption of Hospice and What the Private Public Partnership under the Federal False Claims Act Is Doing about It. American Criminal Law Review, 53(1), 33.
Gaitonde, R., Oxman, A. D., Okebukola, P. O., & Rada, G. (2016). Interventions to reduce corruption in the health sector. Cochrane Database Syst Rev, 16(8). https://doi.org/10.1002/14651858.cd008856.pub2