Mitigating Waste, Fraud, and Abuse in Health Service Management

This essay delves into the critical issues of waste, fraud, and abuse within the Canadian Medicare system and its impact on Health and Human Service Management (HHSM). It emphasizes the importance of delivering quality care in nursing homes, securing document exchange through Electronic Health Information (EHR) systems, and overseeing health insurance covers. The ethical code of conduct, including confidentiality, integrity, and professional competence, forms the basis of the conceptual framework, alongside legal acts like the Canada Health Act. The essay assesses these issues using a checklist encompassing leadership, planning, evaluation, and information/financial systems. It also highlights the use of a managerial problem-solving strategy to identify problems and develop solutions, advocating for high-quality services, reduced caregiver abuse, and minimized resource wastage. The paper concludes by stressing the importance of awareness of existing laws and ethical considerations for future managers in the HHSM sector.

Running head: ISSUES IN HEALTH AND HUMAN SERVICE MANAGEMENT 1
Issues in health and human services
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Student’s name
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ISSUES IN HEALTH AND HUMAN SERVICE MANAGEMENT 2
The protection of the Canadian Medicare from waste, fraud, and abuse
The Canadian Medicare program is on the rise as more people are seeing the advantage
of this medical cover all over the Canadian jurisdiction. However, such expansion comes with a
greater risk of exposition to the public abuse, internal waste of resources and increased cases of
fraud by the management in place. This aspect has a great impact on the Health and Human
Service Management and must be controlled if the delivery of the Medicare is to remain on the
top of the list. It is relevant to this sector, the Health and Human Service Management (HHSM),
as it concerns the effectiveness of the delivery of the proposed nationwide care services to all
Canadians through the hands of the health professionals.
I am a strong believer in the best service being delivered to our people here in Canada
and I am part of the health sector. I believe in fair play and strongly dismiss any issues do with
fraud, especially where clients’ lives are at stake. In order to mitigate such issues from
happening, I will ensure that quality care is delivered in the nursing homes, aid in the secure
exchange of document through the Electronic Health Information (EHR) system, and aid in the
overseeing of the health insurance covers available in the market (Ke, Liu, & Tang, 2017).
The applicable ethical code of conduct that will form the basis of my conceptual
framework and guideline include confidentiality, integrity, professional character, objectivity,
and due care with professional competence.
The legal acts that I am aware of include the Assisted Human Reproduction Act,
Agriculture and Agri-Food Administrative Monetary Penalties Act, Canada Health Act, and the
Canada Consumer Product Safety Act as prescribed by our constitution (Norto, 2017). Any

ISSUES IN HEALTH AND HUMAN SERVICE MANAGEMENT 3
person operating in the HHSM sector must be aware of these acts before he or she can administer
any care to the patients and/or even take part in the issuing of the Medicare covers and services.
These issues that are in the HHSM sector can be better assessed using the assessment
checklist that aids in the leadership and organizational environment checklist, planning and
coordination, evaluation and program design, and assessment of the information and financial
systems.
The information that is out of my access is the financial statements of the payments made
by the patients for the medical cover to be administered to them. Access to such information has
been limited since I am informed that the records must be kept safe from third-party access. By
understanding the cash flow of the funds made by the patients, it will be easier to know the
regions that money and other Medicare resources have been misused by those in the leadership
positions.
The basic information that I found was from the participants and/or users of the Medicare
program since they were able to allocate any misuse of the Medicare services, the quality of the
care they received when compared to the cover costs, and the abuse that they, especially the
caregivers, get when administering the care services.
By the use of the managerial problem-solving strategy as given out the case-debriefing
methodology, I was able to identify the problems in this sector and finding the solutions to them
as well through steps 1 to 6 of the strategy (Michael, Ralph, & Thomas, 2009). These steps
included, one, problem identification, secondly underlying assumptions identification, thirdly
involvement of the stakeholders, fourth developing variable options, selecting the best option,
and finally monitoring and evaluating the options selected.

ISSUES IN HEALTH AND HUMAN SERVICE MANAGEMENT 4
By the use of the above managerial problem-solving strategy, I was able to analyze the
best options available and needed to solve these issues in the HHSM sector. I was able to make
sound decisions that limit the management from misusing the Medicare resources.
I am advocating for the best services that are of high quality to be delivered to the
Medicare patients that will reduce the abuse on the caregivers and minimize wasting of the
resources (Grant, 2017).
A future manager should be aware of the existing laws that protect the Medicare patients
as well as the caregivers and be warned of any desire in either looting or misusing the sector’s
resources.

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References
Grant, T. M. (2017). Leadership Strategies for Combating Medicare Fraud.
Ke, B., Liu, N., & Tang, S. (2017). The effect of anti-corruption campaign on shareholder value
in a weak institutional environment:. Evidence from China.
Michael, J. A., Ralph, B., & Thomas, P. (2009). Managing the Challenges in Human Service
Organizations: A Casebook. Sage publication.
Norto, J. A. (2017). Canada Health Act: defend or reform. CMAJ: Canadian Medical
Association Journal, 189(4), E170.