C HAPTER 24 Code Blue Health Science Edition 4. Western Civilization prides itself on having...
-
Upload
keven-tennies -
Category
Documents
-
view
215 -
download
0
Transcript of C HAPTER 24 Code Blue Health Science Edition 4. Western Civilization prides itself on having...
![Page 1: C HAPTER 24 Code Blue Health Science Edition 4. Western Civilization prides itself on having constructed a free society. Basic freedoms include the.](https://reader035.fdocuments.net/reader035/viewer/2022062803/56649c725503460f9492312a/html5/thumbnails/1.jpg)
CHAPTER 24Code Blue Health Science Edition 4
![Page 2: C HAPTER 24 Code Blue Health Science Edition 4. Western Civilization prides itself on having constructed a free society. Basic freedoms include the.](https://reader035.fdocuments.net/reader035/viewer/2022062803/56649c725503460f9492312a/html5/thumbnails/2.jpg)
Western Civilization prides itself on having constructed a free society.
Basic freedoms include the right to: Independent thought Free speech Freedom of religion Freedom to travel Freedom to start and
conduct business
![Page 3: C HAPTER 24 Code Blue Health Science Edition 4. Western Civilization prides itself on having constructed a free society. Basic freedoms include the.](https://reader035.fdocuments.net/reader035/viewer/2022062803/56649c725503460f9492312a/html5/thumbnails/3.jpg)
Freedom is the right to be wrong, not the right to do wrong. --John George Diefenbaker, 13th Prime Minister of Canada
![Page 4: C HAPTER 24 Code Blue Health Science Edition 4. Western Civilization prides itself on having constructed a free society. Basic freedoms include the.](https://reader035.fdocuments.net/reader035/viewer/2022062803/56649c725503460f9492312a/html5/thumbnails/4.jpg)
Free societies are based on honesty and trust
This is especially true in the area of business, but it is also true in the area of healthcare.
![Page 5: C HAPTER 24 Code Blue Health Science Edition 4. Western Civilization prides itself on having constructed a free society. Basic freedoms include the.](https://reader035.fdocuments.net/reader035/viewer/2022062803/56649c725503460f9492312a/html5/thumbnails/5.jpg)
Fraud is deception intended to result in financial or personal gain.
![Page 6: C HAPTER 24 Code Blue Health Science Edition 4. Western Civilization prides itself on having constructed a free society. Basic freedoms include the.](https://reader035.fdocuments.net/reader035/viewer/2022062803/56649c725503460f9492312a/html5/thumbnails/6.jpg)
Contracts could not be written because society as a whole didn’t keep promises
Checks could not be written because people as a whole would write them with no money in the bank
![Page 7: C HAPTER 24 Code Blue Health Science Edition 4. Western Civilization prides itself on having constructed a free society. Basic freedoms include the.](https://reader035.fdocuments.net/reader035/viewer/2022062803/56649c725503460f9492312a/html5/thumbnails/7.jpg)
Credit cards could not be issued because people as whole would not pay make their credit card payments
Banks could not loan money because society as a whole refused to make their payments
![Page 8: C HAPTER 24 Code Blue Health Science Edition 4. Western Civilization prides itself on having constructed a free society. Basic freedoms include the.](https://reader035.fdocuments.net/reader035/viewer/2022062803/56649c725503460f9492312a/html5/thumbnails/8.jpg)
Couldn’t trust that their physicians and nurses hadn’t cheated in school
Couldn’t trust doctors to know and choose the best treatments
![Page 9: C HAPTER 24 Code Blue Health Science Edition 4. Western Civilization prides itself on having constructed a free society. Basic freedoms include the.](https://reader035.fdocuments.net/reader035/viewer/2022062803/56649c725503460f9492312a/html5/thumbnails/9.jpg)
Couldn’t trust hospital nurses not to steal their pain medications
![Page 10: C HAPTER 24 Code Blue Health Science Edition 4. Western Civilization prides itself on having constructed a free society. Basic freedoms include the.](https://reader035.fdocuments.net/reader035/viewer/2022062803/56649c725503460f9492312a/html5/thumbnails/10.jpg)
Couldn’t trust nurses and other healthcare professionals to report professional misconduct or observed errors in medication or treatment
![Page 11: C HAPTER 24 Code Blue Health Science Edition 4. Western Civilization prides itself on having constructed a free society. Basic freedoms include the.](https://reader035.fdocuments.net/reader035/viewer/2022062803/56649c725503460f9492312a/html5/thumbnails/11.jpg)
Couldn’t trust licensure organizations to weed out bad professionals
REVOKED
![Page 12: C HAPTER 24 Code Blue Health Science Edition 4. Western Civilization prides itself on having constructed a free society. Basic freedoms include the.](https://reader035.fdocuments.net/reader035/viewer/2022062803/56649c725503460f9492312a/html5/thumbnails/12.jpg)
Is a major problem in both business and healthcare
Costs patients, employers and employees billions of dollars
Erodes the trust that is essential to a free society
![Page 13: C HAPTER 24 Code Blue Health Science Edition 4. Western Civilization prides itself on having constructed a free society. Basic freedoms include the.](https://reader035.fdocuments.net/reader035/viewer/2022062803/56649c725503460f9492312a/html5/thumbnails/13.jpg)
EmbezzlementStealing trade secretsOverbillingFalsification of recordsDeceptive advertisingProduction of shoddy productsAnd thousands of other practices
that most people recognize as dishonest
![Page 14: C HAPTER 24 Code Blue Health Science Edition 4. Western Civilization prides itself on having constructed a free society. Basic freedoms include the.](https://reader035.fdocuments.net/reader035/viewer/2022062803/56649c725503460f9492312a/html5/thumbnails/14.jpg)
Performing unnecessary services solely for the purpose of billing insurance or patients
Billing for unnecessary excessive services
Billing for more expensive products and services than were provided
![Page 15: C HAPTER 24 Code Blue Health Science Edition 4. Western Civilization prides itself on having constructed a free society. Basic freedoms include the.](https://reader035.fdocuments.net/reader035/viewer/2022062803/56649c725503460f9492312a/html5/thumbnails/15.jpg)
Billing for products and services that were not provided
Billing for the same products and services twice
Inflating the diagnosis under DRG reimbursement to increase payment
![Page 16: C HAPTER 24 Code Blue Health Science Edition 4. Western Civilization prides itself on having constructed a free society. Basic freedoms include the.](https://reader035.fdocuments.net/reader035/viewer/2022062803/56649c725503460f9492312a/html5/thumbnails/16.jpg)
Certifying that treatments that are not covered by insurance plans are medically necessary when they are not
![Page 17: C HAPTER 24 Code Blue Health Science Edition 4. Western Civilization prides itself on having constructed a free society. Basic freedoms include the.](https://reader035.fdocuments.net/reader035/viewer/2022062803/56649c725503460f9492312a/html5/thumbnails/17.jpg)
Providing a false diagnosis to justify tests, procedures, products or surgeries that are not necessary
Accepting kickbacks for patient referrals
Waiving patient co-pays or deductibles and over-billing the insurance carrier or benefit plan
![Page 18: C HAPTER 24 Code Blue Health Science Edition 4. Western Civilization prides itself on having constructed a free society. Basic freedoms include the.](https://reader035.fdocuments.net/reader035/viewer/2022062803/56649c725503460f9492312a/html5/thumbnails/18.jpg)
Stealing hospital propertyFalsifying pay card dataStealing drugsFalsifying medical recordsAnd so on
![Page 19: C HAPTER 24 Code Blue Health Science Edition 4. Western Civilization prides itself on having constructed a free society. Basic freedoms include the.](https://reader035.fdocuments.net/reader035/viewer/2022062803/56649c725503460f9492312a/html5/thumbnails/19.jpg)
Investigators have shown the following conditions are needed: A financial need on the part of the
employee (it could also be a drug need for an addicted employee)
An opportunity due to poor controls A low probability of being caught
![Page 20: C HAPTER 24 Code Blue Health Science Edition 4. Western Civilization prides itself on having constructed a free society. Basic freedoms include the.](https://reader035.fdocuments.net/reader035/viewer/2022062803/56649c725503460f9492312a/html5/thumbnails/20.jpg)
It was owed to me i.e. “I am not paid enough”
Everyone else is doing it It won’t be missed I will pay it back later
![Page 21: C HAPTER 24 Code Blue Health Science Edition 4. Western Civilization prides itself on having constructed a free society. Basic freedoms include the.](https://reader035.fdocuments.net/reader035/viewer/2022062803/56649c725503460f9492312a/html5/thumbnails/21.jpg)
Vary rarely does one go from being a totally honest person to a “crook” in one step.
Usually it is a slow, incremental process.
Studies show that people get involved in fraud one step at a time.
![Page 22: C HAPTER 24 Code Blue Health Science Edition 4. Western Civilization prides itself on having constructed a free society. Basic freedoms include the.](https://reader035.fdocuments.net/reader035/viewer/2022062803/56649c725503460f9492312a/html5/thumbnails/22.jpg)
Having taken the first step It is easy to rationalize the
second step It is sometimes necessary to take the
second step to cover the first
![Page 23: C HAPTER 24 Code Blue Health Science Edition 4. Western Civilization prides itself on having constructed a free society. Basic freedoms include the.](https://reader035.fdocuments.net/reader035/viewer/2022062803/56649c725503460f9492312a/html5/thumbnails/23.jpg)
People will sometimes do things as a part of a group that they would never do individually.
This is known as the “mob mentality.”
![Page 24: C HAPTER 24 Code Blue Health Science Edition 4. Western Civilization prides itself on having constructed a free society. Basic freedoms include the.](https://reader035.fdocuments.net/reader035/viewer/2022062803/56649c725503460f9492312a/html5/thumbnails/24.jpg)
Investigators who have researched large corporate fraud have often found that those involved did it out of a senses of false loyalty to the boss or to the organization.
![Page 25: C HAPTER 24 Code Blue Health Science Edition 4. Western Civilization prides itself on having constructed a free society. Basic freedoms include the.](https://reader035.fdocuments.net/reader035/viewer/2022062803/56649c725503460f9492312a/html5/thumbnails/25.jpg)
We love people, but we are loyal to principles.
When an employer hires you, he or she buys your talent, time, and best efforts.
![Page 26: C HAPTER 24 Code Blue Health Science Edition 4. Western Civilization prides itself on having constructed a free society. Basic freedoms include the.](https://reader035.fdocuments.net/reader035/viewer/2022062803/56649c725503460f9492312a/html5/thumbnails/26.jpg)
During the years that the author was a hospital administrator, he was surprised many times by the lack of integrity showed by business organizations, healthcare organizations, and employees.
Make a decision early in your career to be honest.
Draw a line, so to speak, as to what you will never do and then never cross it.
![Page 27: C HAPTER 24 Code Blue Health Science Edition 4. Western Civilization prides itself on having constructed a free society. Basic freedoms include the.](https://reader035.fdocuments.net/reader035/viewer/2022062803/56649c725503460f9492312a/html5/thumbnails/27.jpg)
Wes Douglas is discovering various instances of dishonesty and fraud in his hospital.
The best way to correct this in the future will be to: Establish clear cut policies on employee
behavior. Establish controls to prevent employees from
stealing hospital assets. Establish a good audit program to see that
policies and controls are working.
![Page 28: C HAPTER 24 Code Blue Health Science Edition 4. Western Civilization prides itself on having constructed a free society. Basic freedoms include the.](https://reader035.fdocuments.net/reader035/viewer/2022062803/56649c725503460f9492312a/html5/thumbnails/28.jpg)