You lead a multi-disciplinary team that deals with compliance issues for GoodHealth, Inc., a large healthcare provider that owns four hospitals. Your team did some investigating, including internal audits and confidential interviews, and they found the following:
- (1) the provider seems to have imposed budgetary constraints that they knew or should have known would prevent facilities from providing adequate care;
- (2) care that is not of acceptable quality is being provided;
- (3) there are medical coding errors going five years back that will likely total millions of dollars;
- (4) medical errors are not being consistently reported; and,
- (5) physician peer review for medical errors is not taking place in a consistent or timely manner.
Your team has concluded that it is in the best interest of GoodHealth, Inc. to self-report to the OIG. The team must prepare a paper and presentation for the CEO. The CEO will submit the paper to the Board of Directors. Be creative. How should this be approached?
Write one page summary or audit out of text or finding above. Be creative
Expert Solution Preview
Introduction:
As a Medical Professor responsible for creating college assignments and evaluating student performance, it is critical to understand the importance of compliance and quality care in the healthcare industry. Therefore, when tasked with the responsibility of leading a multi-disciplinary team that deals with compliance issues for a large healthcare provider, it is crucial to approach the situation with a creative and effective strategy.
Answer:
Based on the findings of the internal audits and confidential interviews conducted by the team, it is evident that GoodHealth, Inc. is not meeting the required standards for quality care and medical compliance. The health care provider has imposed budgetary constraints that have compromised the facilities’ ability to provide adequate care, which is unacceptable.
Moreover, the medical coding errors dating back five years, coupled with the failure to report medical errors consistently and the lack of timely physician peer review for medical errors, indicates a lack of compliance in the healthcare provider’s operations.
Given the seriousness of the findings, it is imperative that GoodHealth, Inc. self-reports to the OIG to avoid possible legal and financial ramifications. Therefore, the multi-disciplinary team must prepare a paper and presentation for the CEO, highlighting the findings and the need for self-reporting to the OIG.
To approach this issue creatively, the team could leverage technology to create a visually appealing and interactive presentation that highlights the key findings and their impact on the healthcare provider’s operations. The team could also use real-world case studies to demonstrate the adverse effects of non-compliance in the healthcare industry, which could add weight to their argument for self-reporting to the OIG.
In summary, the multi-disciplinary team’s approach to the situation should be based on a creative and effective strategy that leverages technology and real-world case studies to highlight the findings and the importance of self-reporting to the OIG.
