Health Care Fraud

Fraud is an ethical topic that is very common these days. There are many stories pertaining to health care fraud, but there was one that caught my interest. I enjoy watching documentaries because they give me information about significant stories that happened when I was younger or did not understand when they were developing at the time. There was a documentary about a podiatrist practicing in Nassau County, New York. A couple of years ago, a doctor was accused of billing Medicaid and Medicare for patients who were dead ("DA arrests jericho," 2008). The doctor was also creating charges for patients who had only seen him once. He was reporting to Medicare and Medicaid that he had seen these patients on several occasions. He was even billing Medicaid and Medicare for patients he never seen before. The podiatrist got away with this for 18 months.

It seems that this has not been the only case in which health care providers are billing third party payers for patients who are no longer living. Not only is this behavior illegal, but it is also unethical. The activity these providers are participating in, affects many people. It affects the patients, the payers, and the families of the victims. If I found out that a health care professional was using a deceased relative’s information to gain profits, it would saddened and upset me. I would ensure that this was reported immediately.

As health care administrators must make every attempt to ensure employees are not participating in fraudulent behavior. This could come in various forms such as accepting bribes, double charging and others. Fraud does not benefit anyone and could pose harm to many people. Causing harm is not considered an ethical principle. One of the duties of the health care administrator is to reinforce ethical principles and standards to the employees. This expresses the seriousness of ethics to employees.

Additionally the administrators can explain the consequences behind participating in fraud which could hopefully decrease the likelihood that employees will partake in the behavior. The Nassau County podiatrist was able to bill Medicare and Medicaid himself and did not have an executive monitoring his actions, therefore he was able to get away with it until the government got involved. This is a step that health care administrators want to avoid. Therefore, educating employees is essential in terms of ethical dilemmas.

I enjoy expressing which ethical principles or morals that were violated in each case. Although it would seem that professionals should know why certain actions are unethical, sometimes it is hard to determine that. In the case of this podiatrist, autonomy was violated because patients were not able to make their own decisions regarding the billing because they were unaware that their information was being used. The podiatrist also did not demonstrate beneficence, he actions were not representative of “doing good”. The podiatrist was also not being conscientious or honest in this case.

Having “morals” is an aspect of life that people assume others have, but in cases like these, it is safe to assume that not everyone has the same morals and ethical principles.

References

Da arrests jericho doctor. (2008, March 21). Retrieved from http://www.antonnews.com/syossetjerichotribune/2008/03/21/news/