Healthcare Fraud Abuse Please summarize a recent article wi

Healthcare Fraud & Abuse

Please summarize a recent article (within the last five years) about healthcare fraud and/or abuse case. The article should refer to one of the following laws: False Claims Act, Anti-Kickback Statute, or the Physician Self-Referral Law. Could this have been prevented? Why or why not? How could the I (Integrity) from the \"PRICE of Success\" be used to prevent or deter healthcare fraud and abuse from occurring in the medical field?

Solution

Article:

\"These dentists gave kids unnecessary root canals. Then they billed Medicaid for it, prosecutors say\" by Jared Gilmour; January 10, 2018; Star-Telegram

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A dental clinic named Kool Smile was alleged to pressurize its dentists to perform unnecessary root canals to children over the 17 states and claimed the Medicaid amount by mentioning that the procedure was a medical necessity. The US Justice Department reached a settlement with Benevis LLC (through which Kool Smiles is affiliated) over False Claims Act allegations. The settlement will require Benevis and the clinics to pay more than $24 million. The issue was reported by the internal whistleblowers on which investigations were carried out before reaching the conclusion. It was also alleged that Kool Smiles has ignored the dentist\'s voice to stop this abuse and adopted practices such as unnecessary root canals, giving unnecessary stainless steel crowns to the children, and claiming Medicaid for producers which have actually never performed even. The clinic even classified dentists as \'unproductive\' who didn\'t abide by the procedures of attempting unnecessary root canals.

The issue could have been avoided at its inception if all the dentists were following the standards of integrity. The dentists (some of them) were motivated to pursue self-objectives of being high performer making an abuse to the universal standard which refers to doing no harm to the patients. Another way to strengthen the system was to encourage people to come out with reporting practices which are a gross violation of safety at their employer\'s end or which are an abuse of public healthcare. The regulatory agencies have partially addressed this issue by awarding the two whistleblowers with a sum of $2.4 million from the settlement amount. But the point is to create this awareness and motivation in general among the physicians so that the providers cannot attempt such abuse.

The Integrity(I) in the P.R.I.C.E. of Success framework is defined as an assurance of a person in his/ her workplace that he/ she will -

The dentists should have followed this principle in their practice and refrained from operating when unnecessarily. Following rules and policies do not reply that illegal rules have to be followed as well. So, the dentists should have resisted the attempt of their employer. When it comes to goals and objective, any physicians ultimate objective is to protect the patient\'s health at any cost. The dentists could have put efforts to accomplish such goals.