Fraudulent Billing and Legal Implications Essay
Order ID 53563633773 Type Essay Writer Level Masters Style APA Sources/References 4 Perfect Number of Pages to Order 5-10 Pages
Fraudulent Billing and Legal Implications Essay
Fraudulent, Billing, Legal, Implications, Essay
In the article by Brenner, Teo, and Bal (2017), it is explained that the United States has the highest healthcare expenditures of other nations, such as the United Kingdom, Australia, Germany, and France, and that the federal government is concerned that fraudulent billing may be responsible. Fraudulent billing is when a healthcare provider attempts to obtain monetary gain from any healthcare benefit program through false billing or other misrepresentations (Brenner, Teo, & Bal, 2017).
A statute titled 18 U.S.C. § 1347 states that in order for the government to obtain conviction, the guilty party is not required to have knowledge of the relevant law or specific intent to commit violation of that law (Brenner, Teo, & Bal, 2017). Many healthcare providers will receive penalties and fines for fraudulent billing, but criminal penalties, such as prison, are also a possibility (Brenner, Teo, & Bal, 2017).
Collaborative Versus Independent Practice
A nurse practitioner is always responsible for the care that she gives to her patient, regardless of practicing independently or collaboratively. The well-written medical record is imperative because it may be the only defense for the nurse practitioner in a claim of fraud or malpractice.
Being found guilty of billing fraud may result in being unable to bill insurance and maintain licensure (Dolan & Farmer, 2016). The medical record can demonstrate that fraud did not occur, the standard of care was met, safety principles were followed, and the best practice was rendered (Dolan & Farmer, 2016).
The primary difference in fraudulent billing between collaborative and independent practice is that when services are billed under the collaborating physicians NPI number, that physician may incur repercussions, as well (Rapsilber, 2019).
These repercussions include jail time, fines, and relinquishing of ability to bill insurances (Rapsilber, 2019). Executives in positions of authorities can, also, be held accountable due to failure in its oversight duty to monitor (Brenner, Teo, & Bal, 2017).
Brenner, L. H., Teo, W. Z. W., & Bal, B. S. (2017). Medicolegal sidebar: expanding hospital liability-the concept of willful blindness. Clinical Orthopaedics & Related Research, 475(5), 1315. https://search-ebscohost-com.ezp.waldenulibrary.org/login.aspx?direct=true&db=edb&AN=122406803&site=eds-live&scope=site.
Dolan, C. M., & Farmer, L. J. (2016). “Let the record speak. . .”: The power of the medical record. The Journal for Nurse Practitioners, 12(2), 88–94. https://doi-org.ezp.waldenulibrary.org/10.1016/j.nurpra.2015.09.018
Rapsilber, L. (2019). Coding & billing practices. Incident to billing in a value-based reimbursement world. Nurse Practitioner, 44(2), 15–17. https://doi-org.ezp.waldenulibrary.org/10.1097/01.NPR.0000552680.76769.e5.
QUALITY OF RESPONSE NO RESPONSE POOR / UNSATISFACTORY SATISFACTORY GOOD EXCELLENT Content (worth a maximum of 50% of the total points) Zero points: Student failed to submit the final paper. 20 points out of 50: The essay illustrates poor understanding of the relevant material by failing to address or incorrectly addressing the relevant content; failing to identify or inaccurately explaining/defining key concepts/ideas; ignoring or incorrectly explaining key points/claims and the reasoning behind them; and/or incorrectly or inappropriately using terminology; and elements of the response are lacking. 30 points out of 50: The essay illustrates a rudimentary understanding of the relevant material by mentioning but not full explaining the relevant content; identifying some of the key concepts/ideas though failing to fully or accurately explain many of them; using terminology, though sometimes inaccurately or inappropriately; and/or incorporating some key claims/points but failing to explain the reasoning behind them or doing so inaccurately. Elements of the required response may also be lacking. 40 points out of 50: The essay illustrates solid understanding of the relevant material by correctly addressing most of the relevant content; identifying and explaining most of the key concepts/ideas; using correct terminology; explaining the reasoning behind most of the key points/claims; and/or where necessary or useful, substantiating some points with accurate examples. The answer is complete. 50 points: The essay illustrates exemplary understanding of the relevant material by thoroughly and correctly addressing the relevant content; identifying and explaining all of the key concepts/ideas; using correct terminology explaining the reasoning behind key points/claims and substantiating, as necessary/useful, points with several accurate and illuminating examples. No aspects of the required answer are missing. Use of Sources (worth a maximum of 20% of the total points). Zero points: Student failed to include citations and/or references. Or the student failed to submit a final paper. 5 out 20 points: Sources are seldom cited to support statements and/or format of citations are not recognizable as APA 6th Edition format. There are major errors in the formation of the references and citations. And/or there is a major reliance on highly questionable. The Student fails to provide an adequate synthesis of research collected for the paper. 10 out 20 points: References to scholarly sources are occasionally given; many statements seem unsubstantiated. Frequent errors in APA 6th Edition format, leaving the reader confused about the source of the information. There are significant errors of the formation in the references and citations. And/or there is a significant use of highly questionable sources. 15 out 20 points: Credible Scholarly sources are used effectively support claims and are, for the most part, clear and fairly represented. APA 6th Edition is used with only a few minor errors. There are minor errors in reference and/or citations. And/or there is some use of questionable sources. 20 points: Credible scholarly sources are used to give compelling evidence to support claims and are clearly and fairly represented. APA 6th Edition format is used accurately and consistently. The student uses above the maximum required references in the development of the assignment. Grammar (worth maximum of 20% of total points) Zero points: Student failed to submit the final paper. 5 points out of 20: The paper does not communicate ideas/points clearly due to inappropriate use of terminology and vague language; thoughts and sentences are disjointed or incomprehensible; organization lacking; and/or numerous grammatical, spelling/punctuation errors 10 points out 20: The paper is often unclear and difficult to follow due to some inappropriate terminology and/or vague language; ideas may be fragmented, wandering and/or repetitive; poor organization; and/or some grammatical, spelling, punctuation errors 15 points out of 20: The paper is mostly clear as a result of appropriate use of terminology and minimal vagueness; no tangents and no repetition; fairly good organization; almost perfect grammar, spelling, punctuation, and word usage. 20 points: The paper is clear, concise, and a pleasure to read as a result of appropriate and precise use of terminology; total coherence of thoughts and presentation and logical organization; and the essay is error free. Structure of the Paper (worth 10% of total points) Zero points: Student failed to submit the final paper. 3 points out of 10: Student needs to develop better formatting skills. The paper omits significant structural elements required for and APA 6th edition paper. Formatting of the paper has major flaws. The paper does not conform to APA 6th edition requirements whatsoever. 5 points out of 10: Appearance of final paper demonstrates the student’s limited ability to format the paper. There are significant errors in formatting and/or the total omission of major components of an APA 6th edition paper. They can include the omission of the cover page, abstract, and page numbers. Additionally the page has major formatting issues with spacing or paragraph formation. Font size might not conform to size requirements. The student also significantly writes too large or too short of and paper 7 points out of 10: Research paper presents an above-average use of formatting skills. The paper has slight errors within the paper. This can include small errors or omissions with the cover page, abstract, page number, and headers. There could be also slight formatting issues with the document spacing or the font Additionally the paper might slightly exceed or undershoot the specific number of required written pages for the assignment. 10 points: Student provides a high-caliber, formatted paper. This includes an APA 6th edition cover page, abstract, page number, headers and is double spaced in 12’ Times Roman Font. Additionally, the paper conforms to the specific number of required written pages and neither goes over or under the specified length of the paper.
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