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APA
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Health, Medicine, Nursing
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Research Paper
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English (U.S.)
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Topic:

HSA3111: U.S. HEALTH CARE SYSTEMS. MEDICAL FRAUD.

Research Paper Instructions:

This is for my HSA3111: U.S. HEALTH CARE SYSTEMS SPRING 2020 Course
Current Heath Events Papers (CHEPS):
The purpose of the Current Health Events Papers (CHEPS) is to succinctly describe a health issue in the U.S. health care system that needs to be reformed and offer recommendations for resolving the issue (a separate issue per paper).
Paper Format: APA 7.0 writing style (title page, font, font size, spacing, margins, paragraph alignment, and heading).
Title page includes CHEP # 2 and list of textbook chapters cited. Paper should include title page, max of three (3) pages of actual content, and a Reference page (max of five (5)pages total). All resources are cited within the body of the paper and included in the References in correct APA 7.0 style.
Task 1: CHEP#2 Topic: MEDICAL FRAUD
Task 2: Research CHEP#2 Topic: MEDICAL FRAUD: use three sources in your CHEP in addition to your textbook (one source from each category). Please do not use more than three(3) sources and the textbook for the CHEP.
• Newspaper or radio commentaries article—the published dates of your news articles and/or radio commentaries/podcasts should be January 2020 or later.
• YouTube Video—the published date should be 2010 or later.
• Peer-reviewed journal article—the published date should be 2010 or later. Note that editorials, commentaries, book reviews, etc. although from a peer reviewed journal are not peer-reviewed articles.
• The following resources will help you to identify what constitutes a peer-reviewed journal article:
o Angelo State University: How to Recognize Peer Reviewed (Refereed Journals) —http://www(dot)angelo(dot)edu/services/library/handouts/peerrev.php
o John Jay College of Criminal Justice: Evaluating Information Sources—http://guides(dot)lib(dot)jjay(dot)cuny(dot)edu/c.php?g=288333&p=1922599h
o Textbook chapters—integrate at least two(2) of the following course chapters into your CHEP: 1, 3, 4, 5, 7, 12, 13, and 14.
• Your sources must have some relevance to the course. The articles must relate to the issue that needs reform. Please exclude articles from abstracts, blogs, organizational websites, organizational newsletters, WebMD, Wikipedia, press releases, Letters to the Editor, editorials, reviews or summaries of articles and other resources we have used for this course for discussion assignments.
• Do not use sources we have used previously in the course.
CHEP Activities
Task 3: Write CHEP#2. Using the sources, you selected for your topic, write your paper. Include a clear introduction with statistics and a clear thesis statement. Be sure to identify and describe at least three reasons for the issue that needs to be reformed and explain at least three approaches to resolving the issue.
Components in the paper points (follow outline below when writing)
Introduction: Start with an attention grabber (short story, example, statistic) that introduces issue. Give an overview of the issue. Highlight background information on the issue to facilitate understanding of the issue. End with a thesis statement (1 – 2 sentences) that tell what the paper will focus on and briefly outline the main points of the paper. Be sure to identify three causes of the issue and three solutions for resolving the issue.
Body: Clearly describe the three causes of the issue as listed in the thesis. Give strong examples, details, and explanations to support each main point. Provide three solutions to the issue and rationale for why these solutions will solve the issue. Support your points using cited information from your resources including your textbook.
Conclusion: Restate your thesis from the introduction in different words. Briefly summarize each main point found in the paper (avoid going over two sentences for each point). Give a statement of why this issue needs to be resolved in the U.S. health care system and consequences of not addressing the issue. End with a strong clincher statement (an appropriate, meaningful final sentence that ties the issue of the paper to course).
Paper Format: Paper is formatted using correct APA 7.0 writing style (title page, font, font size, spacing, margins, paragraph alignment, and heading). Title page includes CHEP number and list of textbook chapters cited. Paper should include title page, max of three pages of actual content, and a Reference page (max of five pages total). All resources are cited within the body of the paper and included in the References in correct APA 7.0 style.

Research Paper Sample Content Preview:

Medical Fraud
Tarlini
Health Services Administration, Santa Fe College
HSA3111: U.S. Health Care Systems
CHEP Number: 2
Chapters Listed: 12
3/18/2020
Medical Fraud in the U.S.
Fraud in Medicaid has resulted in the U.S. losing billions of dollars each year, resulting in diversion of funds that can enhance the efficiency of delivery of healthcare services. Fraudulent practices increase the cost of delivering Medicare and Medicaid and do not add any value to it. They also increase the potential harm and risk to which patients are subjected due to inclusion of unnecessary medical procedures. For instance, improper payments in 2015 amounted to over $29 billion, and this included such frauds as paying for non-covered services or failure to deliver services after they are billed (Drabiak & Wolfson, 2020). Notably, medical fraud is rapidly rising in America despite government efforts to curb it, and this is attributed to such practices as billing patients for services that are unnecessary or which have not been performed, falsification of diagnoses or claims, and participation in kickbacks or illegal referrals. However, the government in partnership with National Health Care Anti-Fraud Association (NHCAA) can curb this fraud through creating public awareness, implementing strict measures and punishment on medical fraud offenders, and enforcing policy that promotes equitable utilization of medical resources.
According to an article published on NBC News on June 28, 2018, the U.S. Justice Department had announced that it had charged 601 people with multiple counts of medical fraud, among them doctors (U.S. charges hundreds in major health care fraud, opioid crackdown, 2018). The fraud had contributed to losses amounting to more than $2 billion and promoted the opioid epidemic that the country was fighting at the moment.
The arrests of the suspects resulted from the healthcare fraud takedown that was conducted in the country and branded the largest to have ever taken place in the U.S. history. It ended up in 162 suspects, among them doctors, being charged with fraud for the roles they played in distributing and prescribing opioid to patients (U.S. charges hundreds in major health care fraud, opioid crackdown, 2018). In this crackdown, officials wanted to demonstrate their commitment to combatting the opioid issue facing the nation. Data compiled by the U.S. Centers for Disease Control and Prevention shows that the opioid epidemic accounted for the death of over 42,000 people due to overdose in the country in 2016 alone.
Office of Inspector General in the U.S. Department of Health and Human Services recently released data that showed that approximately 460,000 individuals who were covered by Medicaid and Medicare had received opioids in excess dosages in 2017, and around 71,000 of the recipients were exposed to the risk of overdose or misuse (U.S. charges hundreds in major health care fraud, opioid crackdown, 2018). In 2018, the federal government reported that it had spent over $3.6 trillion on health care, with this amount being spent on health insurance claims. However, there is adequate evidence that some of the health insurance claims were fraudulent. Although they are only a few, they are associated with ...
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