Free Essay

Law and Ethics

In: Social Issues

Submitted By Naya250
Words 627
Pages 3
Major Laws Concerning Fraud and Abuse
Anna Afoakwa
Health Information- Law and Ethics (Summer Quarter)

Author Note:
This assignment is being submitted as module 9 assignment

Healthcare ethical behavior is an important topic in health industry. Ethics or moral behavior is the ground on which humanity stands for a compatible existence. The word ‘ethics’ means different to different people and is based on moral, philosophic and religious principles of the society in which it is practiced. All problems of life have solutions, but all solutions are not based on moral principles. Principles alone do not lead to ethical decisions; decisions without principles are ethically empty. Below are the seven major laws concerning fraud and abuse. The False Claims Act: imposes liability upon any person who knowingly submits or causes the submission of false or fraudulent claims for payment or approval. In the healthcare context, examples of conduct that can arguably lead to charges of violations of the statute include, but are not limited to: billing for medical services not rendered; misrepresenting the level of services rendered; falsely certifying compliance with federal laws; and submitting a claim for payment that is contrary to Medicare or Medicaid payment requirements.
The Federal Anti-Kickback Statute: prohibits providers of services or goods covered by a federal healthcare program ("Federal Healthcare Program") from knowingly and willingly soliciting or receiving or providing any remuneration, directly or indirectly, in cash or in kind, to induce either the referral of an individual, or furnishing or arranging for a good or service for which payment may be made under a Federal Healthcare Program.
The Stark Law: also known as the "Physician Self-Referral Statute", generally prohibits the referral of Medicare and Medicaid beneficiaries by a physician to an entity for the provision of "designated health services" if the doctor, or the physician's immediate family member, has a financial relationship with the entity, unless a statutory exception applies to that financial relationship.
Mail and wire fraud statues: Mail fraud, stated simply, is defrauding another person or entity as a result of using a postal service. Mail fraud is almost always committed for the purpose of wrongful financial gain, and this crime can be committed against individuals, businesses, the government, and financial institutions. Mail fraud is a federal crime by nature, as using the postal service to advance a criminal attempt necessarily involves the federal government.
Civil money penalty law: A fine issued in civil court which penalizes a violator who profited from an illegal or unethical action. The penalty is typically equal to the gains made from the activity. For example, a broker who profited $1,000 from circular trading will be required to pay a fine of at least $1,000.
Deficit Reduction Act of 2005: provides States with much of the flexibility they have been seeking over the years to make significant reforms to their Medicaid Programs. States can expand access to affordable mainstream coverage, promote personal responsibility for health and accessing health care, and improve quality and coordination of care.
Qui tam actions: from Latin for “who as well”, a lawsuit brought by a private citizen (popularly called a "whistle blower") against a person or company who is believed to have violated the law in the performance of a contract with the government or in violation of a government regulation, when there is a statute which provides for a penalty for such violations.
The findings of this study suggest that health care ethical behavior differs among individual staffs, and such behavior is influenced directly by individuals’ subjective norm, attitude, perceived behavioral control and ethical Judgments, as well as indirectly by idealism and relativism.

References
Hassan KZ (1994) Introduction to ethics in health care system. Retrieved from http://www.duhs.edu.pk/download/issue.pdf

Similar Documents

Premium Essay

It Law and Ethics

...Chapter 11 Law and Ethics Chapter Overview Chapter 11 covers the topics of law and ethics. In this chapter readers will learn to identify major national and international laws that relate to the practice of information security as well as come to understand the role of culture as it applies to ethics in information security. Chapter Objectives When you complete this chapter, you will be able to: Differentiate between law and ethics Identify major national and international laws that relate to the practice of information security Understand the role of culture as it applies to ethics in information security Access current information on laws, regulations, and relevant professional organizations Set-up Notes This chapter could be completed in a single class session, if there is sufficient time to cover the material. Unless the students have not had the opportunity to read the material in advance (in some settings, the textbooks are not made available until the first class meeting), it may be prudent to have a general discussion of the topic, with detailed lecture to follow at the next class meeting. The subject matter can be covered in 1.25 to 2.5 hours. Lecture Notes and Teaching Tips with Quick Quizzes Introduction As a future information security professional, it is vital that you understand the scope of an organization’s legal and ethical responsibilities. To minimize the organization’s liabilities the information security practitioner must understand...

Words: 4470 - Pages: 18

Premium Essay

Laws and Ethics

...Laws and Ethics The Dilemma: A married couple, both addicted to drugs, is unable to care for their infant daughter. She is taken from them by court order and placed in a foster home. The years pass. She comes to regard her foster parents as her real parents. They love her as they would their own daughter. When the child is 9 years old, the natural parents, rehabilitated from drugs, begin court action to regain custody. The case is decided in their favor. The child is returned to them, against her will. Do ethics support the law in this case? The question of whether any school of ethics supports this ruling is not as black and white as it may seem. The Care-based theory of thinking would have you put yourself in the shoes of the foster parents, the child and the biological parents. Putting myself in the foster parent’s shoes, I would feel empathy because they have raised this child as their own for the past 9 years and having to give her up would difficult. At the same time as a foster parent they should know that the possibility existed for this type of situation to happen. For the child these are the only parents she can remember, so this situation is probably confusing to her. Last but not least the biological parents, how are they feeling? If I were them I would want my child back but at this point you have to figure out what is best for the child. If they are truly rehabilitated I believe the ruling is just and ethical. The Care-based theory does indeed support...

Words: 979 - Pages: 4

Premium Essay

Laws and Ethics

...Laws create a guideline for a way a company must run and how it needs to conduct itself. Ethics of a company are a guideline for how the management and employees of a company should conduct themselves regardless of their own personal views and ethics. Laws explain on what we are able to do whereas ethics explains about what we should always do (Ethicaledge, 2008). Both laws and ethics allow a company to run properly. If a company does not run by the laws that are in place they are likely to be ethically unstable as well. Within each company there is a legal system set up made of legal guidelines and regulations that handle different areas of business. This set-up helps in controlling risk, debts and obligations. These laws have the ability to provide members of management with recommendations on how the company should be run. Laws are laws and are set in place. No company has special treatment from these laws. The principles and restrictions that are in position legalize all areas of a business…its investments, employees, and production (SCU, 2008). Because there are laws set forth for companies to follow they are not afforded the ability to fun their company completely in a way they want to. These laws offer regulations for companies to conduct their business which allows for ethical standards to be put in place. These ethical standards are to be followed by all within a company and does not afford special treatment for anyone in higher power. Laws also assist in...

Words: 811 - Pages: 4

Premium Essay

Laws and Ethics

...Law vs. Ethics MGT 101 Seminar Five Summer 2010 Laws and ethics are a touchy subject, even the brightest minds in the world have a tough time coming up with the “right” answer. When applying social responsibility with ethics, we must look at it from multiple sides; let’s use an example, Robert was interested in learning about the workings of professional burglars. Several years ago, he made contact with someone who could put him in touch with a professional burglar, although the burglar had retired several years ago. He contacted this person, who forwarded his interest on to the "retired" professional burglar. The burglar agreed to participate in a series of interviews. The first two interviews went fine, but on the third occasion, his subject indicated that he was planning a burglary in a new development. This was to be a one-time event (rather than a return from retirement) involving burglarizing the home of a wealthy resident in this development. Robert promised his subject anonymity and confidentiality at the outset of his research, but he now had information indicating that a crime was about to be committed. In analyzing laws and ethics in this case, if Robert was being ethical for the integrity of the burglar and did not inform the police of his deeds, he was being unethical in the social responsibility aspect of ethics! When respecting people’s rights, dignity, and diversity, people are going to be affected negatively either way in certain situations. What we need...

Words: 1004 - Pages: 5

Premium Essay

Law and Ethics

...Law, Ethics, and Corporate Governance July 17, 2011 1. Explain where an employee can reasonably expect to have privacy in the workplace. Employees are becoming increasingly concerned about their privacy as their employers are monitoring them electronically more than ever . The best way to ensure the privacy of personal calls made at work is to use your own mobile phone or a local pay phone. Employers are very interested in the loyalty, productivity, and privacy of the employees. Employers usually include privacy policies in the employee handbook that outlines company guidelines when referring to emails and electronic surveillance. The only place an employee can actually expect to have privacy at work is in the restroom. However, this is only to a certain degree since people come in and out of bathrooms on a regular basis. The only laws that govern privacy are outlined in the First, Fourth, Fifth, and Ninth Amendments. These amendments can’t be violated by any government sector. However, these amendments don’t cover the private sector of businesses. Privacy laws in the private sector are dictated by state and federal statutes along with the common law of torts. The tort of intrusion regarding seclusion is used by employees to address an employer’s invasion of privacy by electronic monitoring. The Restatement of Torts 652A (1977) specifically states; “One...

Words: 1092 - Pages: 5

Premium Essay

Law & Ethics

...Assignment: Assignment 1 Title: Employment At-Will Doctrine Student: David Nti-Berko Professor: Anne E. Dewey-Balzhiser Course: LEG 500 – Law, Ethics, and Corporate Governance Submission Date: 07/28/2013 Introduction Since the latter part of the nineteenth century, employment at-will has been the starting point in America employer-employee relationships (D. Mathews, 1975). Under the doctrine of employment at-will, an employer may terminate employees for good cause, bad cause, or no cause at all. Most western industrialized countries do not observe employment at-will doctrine. According to the legal history, employment at-will doctrine is a legal fiction unintentionally invented by Horace C. Wood in his legal thesis in 1877 on employment law entitled “Master and Servant” (Toussaint v. Blue Cross & Blue Shield of Michigan, Mich. 1980). At-will employees can be terminated for any reason or no reason at all. This means that in an at-will workplace there is no esoteric form of fairness or justice that can be protected or enforced by the courts. In the states whereby employment at-will doctrine is observed, an employer or supervisor can terminate an employee because they do not like their style of dress, choice of music or maybe even the color of their shirt, and the employee would have no real legal recourse in most instances. Because employees can be terminated for no reason, it does create a dilemma for...

Words: 2892 - Pages: 12

Premium Essay

Law and Ethics

...Karris Moses Professor Armstrong Law, Ethics and Corporate Governance Assignment 3: Corporate Governance and Ethical Responsibility Research Paper February 17, 2013 Karris Moses Prof. Armstrong LEG 500 February 17, 2013 Dr. DoRight has recently been hired as the President of the “Universal Human Care Hospital”, where he oversees all departments with over 5,000 employees and over 20,000 patients at the medical facility. He has been provided with a broad set of duties and oversight of numerous departments, including business development, customer services, human resources, legal, patient advocacy, to name a few. He has managers in each department that he supervises and who work with him to address the needs of the various internal and external stakeholders of the hospital. Dr. DoRight discovers that some patients within the hospital have been dying as a result of a variety of illegal procedures by doctors and nurses, and negligent supervision and oversight on their part. This was brought to his attention in a few meetings and he told his Regional Director Compliance Manager and Executive Committee in January 2009. He was told by them that the matter would be investigated and they would report any findings to him as soon as possible. After two (2) years, there have been no results from the investigation and some patients are still passing away due to the negligent activities. He also answers to a board of trustees and interfaces with numerous community organizations...

Words: 2595 - Pages: 11

Premium Essay

Law and Ethics

...Electronic Surveillance of Employees Turrochelle McEachern Law, Ethics, and Corporate Governance/ LEG 500 1/23/2011 Professor Eric Baime Electronic Surveillance of Employees Today, technology has increased that it enables us to connect with more people on a broader basis and in quicker ways. Organizations today are faced with the liability of their employees using technology for their own personal gain and thus issues related to workplace privacy. Organizations are coming up with ways and ideas to make sure their employees are being productive and not just goofing off by closely monitoring all types of communication. We will analyze Fade-In-Interior Auto Dealership and the boss’s decision to use surveillance on his employees. In this paper we will discuss where an employee can reasonably expect to have privacy in the workplace, secondly whether or not it makes a difference if an employee is in an open area or in an enclosed office setting. Thirdly, we will explain if Herman’s, the boss at Fade-In-Interior Auto Dealership, need to know whether his salespersons are honest is sufficient grounds for utilizing electronic surveillance. Fourthly, we will explain to what extent an employer can engage in electronic surveillance of employees. In conclusion, we will explain to what extent the inclusion of innocent, unaware third-parties in such surveillance determine whether it is legal. Explain where and employee can reasonably expect to have privacy in the workplace...

Words: 1134 - Pages: 5

Premium Essay

Law and Ethics

...What is corporate social responsibility? Give example about CSR in today’s business * Corporate social responsibility (CSR) is the process by which businesses negotiate their role in society * In the business world, ethics is the study of morally appropriate behaviors and decisions, examining what "should be done” * Although the two are linked in most firms, CSR activities are no guarantee of ethical behavior History * CSR is a form of corporate self regulation turns into business models * Also called corporate conscience, citizenship, social performance, sustainable responsible business * Came into used late 1960s and early 1970s * ISO 26000 recognize CSR standards Bodies that governs CSR through out the world World Business Council for Sustainable Development -Corporate Social Responsibility is the continuing commitment by business to behave ethically and contribute to economic development while improving the quality of life of the workforce and their families as well as of the local community and society at large Business For Social Responisbilities Operating a business in a manner that meets or exceeds the ethical, legal, commercial and public expectations that society has of business The European Commision A concept whereby companies integrate social and environmental concerns in their business operations and in their interaction with their stakeholders on a voluntary basis The ASEAN CSR Networks CSR is about how businesses...

Words: 1040 - Pages: 5

Premium Essay

Law and Ethics

...some will be discuss in details. Ethics is concerned with the study of social morality and philosophical reflection of norms and practice (Burckhardt and Nathaniel 2003). These ethical issues are those based on basic and essential to social values that include respect for life, liberty and to be cared for. There will be a demonstration of understanding the theory of deontology while recognizing the importance of ethical principles in relation on the delivery of individual patient care. Informed consent will be highlighted in detail to provide validity and factors involved. A reflection will be provided to detail the understanding of how ethical theories contribute to the ethical decision making process in clinical area. Also a brief discussion will be given to show what has been gained from producing this essay. Consent can be defined as an agreement to allow something to happen based on full disclosure of facts needed to make an intelligent decision (Hazel 2002). This includes the knowledge of risks involved, benefits and consequence of refusal. Informed consent not only requires that a person be given all relevant information required to reach a decision regarding their treatment. According to (Dimond 2002). The person should have the capacity of understanding the relevant information and does in fact give consent or a procedure is performed on a patient without informed consent the trust might be liable in the court of law . The following factors should be...

Words: 2222 - Pages: 9

Free Essay

Law and Ethics

...In 1998, the South African Law Reform Commission (then the South African Law Commission) published a report and accompanying draft bill covering the same territory as this Position Paper. It was commis-sioned by Pres Nelson Mandela, tabled in Parliament in 2000, but offi-cially ignored by the ministry of health. It should serve as a basis for public debate. Analogously, termination of pregnancy (abortion) legisla-tion was, in part, the outcome of such a public debate and legislative process. Globally, many countries are addressing assisted dying, albeit in dif-ferent ways. Some have legalised assisted dying and others have set cri-teria for not prosecuting it. 8 End-of-Life Decisions, Ethics and the Law In South Africa, the debate should be based on the spirit, values and rights in the Constitution, particularly the interpretation of the right to life and its intimate connection with the right to dignity. Our Constitu-tion should shape a moral community that binds us together as citizens, despite the different personal, ethical and religious beliefs we might have in our local communities. A constitutional democracy means, among others, that we resolve our differences about the social arrange-ment of society by appealing to the Constitution, thus granting others the right to live by their convictions even if we disagree with them. Ultimately, at issue here is the suffering of people in the end-stage of life. Silence is also a choice for which we are responsible. This Position...

Words: 382 - Pages: 2

Premium Essay

Law and Ethics

...Whistleblowing and Sarbanes-Oxley Due Gbemisola Salako Dr. Oris Guillaume LEG 500 – Spring/ 2015 April 21, 2015 Question # 1- Describe the key characteristics of a whistleblower, and briefly summarize one (1) researched instance of whistleblowing in one (1) publicly traded company within the last 12 months. Include the details of the issue that the whistleblower reported and the effect of the whistleblower’s actions on both the whistleblower himself and the company. Whistleblowing can be described as an instance whereby an employee reports suspected wrongdoing such as corruption, mismanagement or corruption at work. It is referred to as making a disclosure in the interest of the public which can occur in a private enterprise or government agency (“Whistleblowing,” 2015). A whistleblower is an individual or employee who reports wrongdoing within an organization. This person draws attention to genuine abuses of power in government and businesses by decision makers. A whistleblower acts in accordance with perceived ethical or legal mandate (Halbert, Ingulli, & Frey, 2015). The key characteristic of a whistleblower is the willingness to sacrifice both professionally and personally to expose wrongdoing such as wastefulness, fraudulent practices and corruption in an organization. Persistence and the ability to assume personal risk are also characteristics of a whistleblower (Heumann, Friedes, Cassak, Wright & Joshi 2013). JPMorgan Chase & Co. was charged with...

Words: 919 - Pages: 4

Free Essay

Law and Ethics

...Assignment #2 – Family Related Issues Law and Ethic in the Business Environment 4/30/2011 1. Explain if it matters that a parent literally had nothing to do with a biological child in order for the child to take advantage of the Family and Medical Leave Act (FMLA) to care for that parent.  It does not matter in the case if the parent is biological or not. A parent is a caregiver. Under the FLMA you are entitled to 12 weeks of unpaid, job protected leave. Because a biological parent did not provide formal care for the child, the child can still use Family leave to care for a seriously ill parent. In Tony’s case he can take time off to care for his father after his surgery. Tony can take the time needed to address his mental and physical needs of himself and his father without risk of losing his job. However just to request time off under the Family leave act to move a parent is not an acceptable leave request and can be denied. If the leave requested is to care for an ill parent then his request under the Family leave act cannot be denied. Under the Family leave act a parent is considered a person who has assumed the responsibilities of caring for a child. Under FLMA the term in loco parentis refers to a person who assumed the relationship with a child in which he or she has no legal or biological connection. So it does not matter whether or not that parent has anything to do with a biological child, they are still eligible to take advantage of...

Words: 1240 - Pages: 5

Premium Essay

Laws and Ethics

...Laws and Ethics Debbie Salmon AIU Online HLTH410-1205A-02 Unit 1 IP Duty oriented ethics focuses on performing ones duty to various people and institutions (Fremgen, B). The duty of the paramedic in the situation is to try to save the people stuck in the cave, since the scout master is stuck the children will have to drown but if the scout master is sacrificed than the children can be saved. In this case the paramedic is put in a situation where a person will die no matter what course is taken; the problem is he has to make the decision as to who will perish. He could say since the scoutmaster is in a safe place he will work on saving him and let the children die or he could say there are too many lives at stake with the children and may opt to sacrifice the scoutmaster to save them. Though this is a difficult situation to be in I think the best option he has is to sacrifice the scoutmaster and save the children because in many instances scoutmasters sign a document that states that they will put themselves in harm’s way to protect the children they are responsible for if the situation arises (aiu live chat archives). Consequence oriented reasoning deals with how we judge the rightness or wrongness of the decisions we make based on what the outcomes are predicted to be. Normally the act that is deemed right is what will bring out the best outcome. In the case of the scoutmaster and scouts, there is not really a right or wrong it is just a very unfortunate event that...

Words: 1392 - Pages: 6

Premium Essay

Law and Ethics

...Unit Two Assignment HS 101 November 18, 2015 Kaplan University Unit Two Assignment   1. Define civil and criminal law. Could these case facts give rise to a criminal case, a civil case, or both?       a. “A criminal action is considered a wrong against society… A civil Action is considered a wrong between individuals” (Caldwell, Connor, 2012, p. 131). These case facts give rise to both criminal and civil cases. First, the teenagers abused the elderly verbally and physically, which should result in some fines paid to the family, making it a civil suit. Next, the teenagers were put in front of a jury, which found them guilty, some were sentenced to jail time, the other sentences varied in charges. The fact that they were put in front of a jury, is what made this case criminal, along with the negligence of the Good Samaritan Home employers and the abuse intended by the teenage nursing aides.   2. What intentional torts do you think the nursing aides committed? Please give a definition for each intentional tort that you choose with an explanation of why you chose that tort.       b. I believe the nursing aides committed assault and battery. “Assault meaning the threat of harm, and battery meaning the actual physical harm to a person” (Caldwell, Connor, 2012, p. 132). I chose assault and battery the Case in Point mentioned that the nursing aides physically and verbally abused the elderly patients, meaning the must have laid their hands on the elderly patients which...

Words: 651 - Pages: 3