Health Care Quality Research Topic – Health Care Fraud & Abuse
The paper will be about health care fraud and abuse cases that health insurance company’s face.
1. Review the types of fraud and abuse cases
2. how it affects the community along with statistics
3. the systems that are put in place to fight fraud
Introduction: Briefly define the health care quality issue and state why the topic is important to study.
Literature Review: Using current literature, describe the details of the issue providing a brief state of the current literature on the topic. You should summarize and synthesize the literature. You can organize the literature chronologically, thematically or methodologically, whichever is best for the topic or your personal writing style. It is extremely important to use the guidance on APA style and appropriately citring your sources. If you are unfamiliar with APA style,
Conclusion/Recommendation: Summarize the key messages from the literature and state your opinion of the literature and recommendations for next steps or solutions to the issue.
•Communication is an essential skill for leaders and managers in health care. The better organized and clearer your writing, the more understandable it will be. Take the time to write and rewrite so that your points are clearly stated, concise and well-supported and so that your ideas as presented in a logical fashion.
•Whenever you refer to the ideas or words of others, make sure you give credit using APA-formatted in-text citations.
•Paper must not be over 10 pages in length (Arial 12 font and double spaced, 1 inch margins)
• Please use the references listed below.
Armour, S. (2015, March 19) The Wall Street Journal, U.S. Recovers $3.3 Billion in Federal Health Care Fraud, Retrieved from http://www.wsj.com/articles/u-s-recovers-3-3-billion-in-federal-health-care-fraud-1426737703
BlueCross BlueShield, Understanding Healthcare Fraud, retrieved from http://www.bcbs.com/report-healthcare-fraud/
Coalition Against Insurance Fraud http://www.insurancefraud.org/statistics.htm#.VqLxVZiFOig
Common Types of Health Care Fraud, retrieved from https://www.cms.gov/Medicare-Medicaid-Coordination/Fraud-Prevention/Medicaid-Integrity-Education/Downloads/fwa-factsheet.pdf
Examples of Healthcare Fraud Investigations – Fiscal year 2014. Retrieved from https://www.irs.gov/uac/Examples-of-Healthcare-Fraud-Investigations-Fiscal-Year-2014
Examples of Healthcare Fraud Investigations – Fiscal Year 2015. Retrieved from
National Health Care Anti-Fraud Association http://www.nhcaa.org/resources/health-care-anti-fraud-resources/the-challenge-of-health-care-fraud.aspx
Rooting out health care fraud is central to the well-being of both our citizens and the overall economy https://www.fbi.gov/about-us/investigate/white_collar/health-care-fraud
Teitelbaum, J. B., & Wilensky, S. E. (2007). Essentials of Health Policy and Law. Sudbury, Mass: Jones and Bartlett
U.S. Department of Health and Human Services, Health Care Fraud and Abuse Control Program Report http://oig.hhs.gov/reports-and-publications/hcfac/
United States Department of Justice, Atlanta Doctor Sentenced For Defrauding Medicare and IRS (2014, February 20). Retrieved from http://www.justice.gov/usao-ndga/pr/atlanta-doctor-sentenced-defrauding-medicare-and-irs