Read Maryland Health Care Provider Sentenced to 10 years in Federal Prison for Health Care Fraud Resulting in Patient Deaths from the United States Attorney’s Office.
Use the 5 Whys to conduct a root cause analysis to determine why the Medicare fraud occurred and Timothy Emeigh’s participation in the case.
Write a 525- to 700-word paper that identifies and evaluates the root cause for Medicare fraud in this case.
Include the following:
- List each of the 5 Whys and your response.
- Speculate as to why Mr. Emeigh participated in the scheme.
- Explain what you might have done to prevent this from happening.
Cite 3 reputable references to support your assignment (e.g., trade or industry publications, government or agency websites, scholarly works, or other sources of similar quality).
Expert Solution Preview
Introduction:
The case of Timothy Emeigh, a Maryland Health Care Provider who was sentenced to 10 years in federal prison for health care fraud resulting in patient deaths, highlights the grave consequences of Medicare fraud. To gain a deeper understanding of the root cause of this case, we will use the 5 Whys approach to conduct a root cause analysis. This paper will identify and evaluate the root cause of Medicare fraud in this case, speculate as to why Mr. Emeigh participated in the scheme, and explain what could have been done to prevent this from happening.
1. List each of the 5 Whys and your response:
Why did the fraudulent billing occur?
Response: The medical provider committed fraudulent billing to increase its revenue.
Why was the medical provider motivated to increase revenue?
Response: The medical provider was motivated to maximize its revenue to benefit its executives and shareholders.
Why did the medical provider prioritize revenue over patient care?
Response: The medical provider prioritized revenue over patient care due to a lack of oversight and regulation.
Why did the lack of oversight and regulation occur?
Response: The lack of oversight and regulation occurred due to the weaknesses in the healthcare system’s regulatory framework.
Why did the weaknesses in the regulatory framework persist?
Response: The weaknesses in the regulatory framework persisted due to insufficient funding and resources allocated to the regulatory agencies.
2. Speculate as to why Mr. Emeigh participated in the scheme:
Mr. Emeigh likely participated in the scheme due to financial gain. He may have been incentivized to submit fraudulent claims to increase the medical provider’s revenue. Additionally, it is possible that Mr. Emeigh was under pressure to meet billing quotas, leading him to participate in the fraudulent scheme. Ultimately, greed and a lack of professional ethics may have motivated Mr. Emeigh’s participation in the fraudulent scheme.
3. Explain what could have been done to prevent this from happening:
To prevent Medicare fraud from occurring, several steps could have been taken. First, the regulatory agencies responsible for overseeing healthcare providers’ activities should have been better-funded with adequate resources to proactively investigate potential fraud. This could include audits and regular inspections of medical providers to identify and prevent fraudulent billing practices. Additionally, stricter penalties and consequences for committing Medicare fraud should be instituted to deter medical providers and their employees from engaging in fraudulent activities. Ensuring that healthcare providers adhere to strict ethical standards is paramount in preventing Medicare fraud, and medical providers should be held accountable for any unethical behavior.
