Contemporary Technological Advanced World People

Running head: HEALTHCARE ORGANIZATION 1
HEALTHCARE ORGANIZATION

HEALTHCARE ORGANIZATION 2
Introduction
According to Taylor, et. al. (2014), in this contemporary technological advanced world
people have come up with ways that are making lives easier in every sector especially in the
healthcare facility. However, organisation tend to misuse the advantages and creates a
significant amount of burden in the society. Therefore, for a comprehensive program was
developed by the U.S. Federation for the healthcare institutions and its workers to conduct
operations ethically. The report aims to identify and elucidate organisations and individuals
on the necessity of healthcare finance compliance practices and the probable unlawful and
regulatory fines which can be forced on the individual or the organization for conducting
financial frauds.
Compliance program
According to MedPro Group (2018), a compliance plan can be referred to as a formal
statement or plan for the healthcare provider to conduct occupational operations, management
procedures as well as patient care and services on ethical grounds. The program aids
institutions and its employees to conduct procedures and actions morally; with the maximum
level of honesty as well as in compliance with permissible and governing needs. To have an
efficient compliance program, the association must launch and uphold the organizational
culture that inspires ethical conduct and a commitment to compliance with the law. As opined
by Health Now (2017), the Health care department and human services have been extensively
working to prevent the fraud and abuse (Drake, Kanu and Silverman, 2013). Therefore, in
1990 the department issued guidelines for a voluntary compliance program, for every
individual and minor healthcare practices. They started providing compliance resources and
tools that will aid the providers and they will avoid submitting inaccurate claims and engage
in illegitimate conduct concerning the federal healthcare schemes.

HEALTHCARE ORGANIZATION 3
As per Robichau (2014), the primary purpose for this formal compliance is two-fold: firstly,
it acts as a blue print for the practice’s compliance plan and achieving the goals; secondly it
inspires the workers to report any unethical misconduct occurring in their institution.
National law entails healthcare to change and introduce the new formal compliance programs
as well as provide a synopsis of the steps taken to ensure they are meeting the guidelines of
the plan. According to Fabrikant, et. al. (2019), an efficient compliance plan is critical as it
prevents form fraudulent claims, inaccurate billings, concocting for possible audits, and
dodging ethical battles in corporate operations as well as patient care facilities. Moreover, if
noncompliance by means of the regulation fallouts in an HHS-OIG criticism as well as
enquiry, penalties can be quite substantial. Simply giving an excuse of not understanding the
regulation or failing to deliver acquiescence training for the workers, will not suffice as an
excuse for abuses.
Healthcare Finance Fraud in local area
As suggested by Sanborn (2018), two major healthcare fraud cases were recorded that alleged
illegal activities by practitioner and physicians. The first case was claimed to be Las Vegas
where a Cardiovascular and Thoracic Surgeons of Nevada had to reimburse $1.5 million to
settle for the claims that they had desecrated the False Claim Act by providing illegitimate
bills. The allegations was that for a period of five years that is, from 1st January 2006 till 31st
May 2011, the physicians despoiled the False Claims Act and billed federal healthcare plans,
that consisted of Medicare as well as the United States (U.S.) Department of Veteran Affairs,
for surgical medical services that were not really rendered to the cardiac patients. The
accusation also stated that they exercise billed for additional luxurious operating, assessment
and administration services.
The second case was from a suburban Illinois where a physician from Palos Medical Care in
Palos Heights was indicated to perform a federal fraud and was accused of pocketing