COM 410 Healthcare Regulatory Environment

Question: Complete the Problem on page 579 of the text as a three to four page paper. For a general description of Marcus Welby Hospital see page 369 of the text. You are outside counsel to the Marcus Welby Healthcare Corporation. which among its other operations owns a durable medical equipment (DME) subsidiary. which sells equipment for home use such as crutches, wheelchairs, and oxygen concentrators. You learn that the subsidiary has had certain business practices about which you have some question under the Medicare and Medicaid Anti •Fraud and Abuse provisions: • Salesmen regularly offer home health agency employees a “premium” whenever their clients order DME from the subsidiary. • The subsidiary offers “rebates” to patients who use its equipment. • The subsidiary pays hospital and home health agency personnel for assisting its patients in learning how to use its products. • Some arterial blood gas test results may have been “massaged a bit” by the DME in order to facilitate Medicare payment for oxygen concentrators. What advice would you give? Answer: Introduction: The Medicare and the Medicaid Anti-Fraud and Abuse provides caution to caregivers against engaging in unlawful acts that can jeopardize the health of the clients (Stowell, Schmidt, & Wadlinger, 2018). Additionally, the provisions state that paying for referrals is an offense. Selling healthcare equipment at a reduced price to get clients is also a crime. Hospitals should train patients on the usage of DME without asking for payment. Caregivers should not ‘doctor’ results to excite patients. This paper will discuss four major concerns that violate the healthcare laws. The first concern is about salesmen regularly offering ‘premiums’ to the employees of home health agencies whenever their clients order DME from the subsidiary. In this context, premiums are incentives to thank the agencies for the referrals. Rewarding individuals for referrals is against the Medicare and Medicaid Anti-Fraud and Abuse provisions in the United States (Clemente, McGrady, Repass, Paul III, & Coustasse, 2018). The Anti-kickback statute prohibits healthcare professionals from paying other agencies for referrals. The law notes that it is legal to pay for referrals in other industries but illegal in the health care programs of the Federal States. Therefore, the salesmen are committing a punishable offense by rewarding the agencies for referrals. I would first explain to the salesman that their actions are against the healthcare laws. A care provider who pays for referrals is subject to jail terms and fines (Pena, Larson, & O’Connor-Barnes, 2016). Secondly, I would caution the home health agencies against asking or accepting payment from the salesmen. The second concern is that the subsidiary offers ‘rebates’ to patients who use its equipment. A rebate is a little refund that the subsidiary gives back to the clients who use equipment like wheelchairs. The facility refunds a little money to the patients to entice them and turn them into loyal customers. The offering of rebates violates the statute on beneficiary inducement. Caregivers who issue remunerations to the beneficiaries of facilities like the DME risk facing monetary penalties from the Federal government (Ghebleh, 2017). The provision understands that caregivers can issue remunerations to persuade the clients to continue using their services. I would advise the employees of the subsidiary against offering rebates to the patient. Furthermore, I would explain the legal consequences of their actions. I would also conduct an awareness campaign to advice the patients against accepting the rebates. The third concern is that the subsidiary pays the agency personnel and the hospital for assisting the patients on the usage of the DME. Like the first two concerns, paying the hospital for helping patients violates the Anti-Fraud laws. The statute on beneficiary inducement prohibits caregivers from accepting gifts or money from a DME supplier (Fabrikant, Kalb, Bucy, Hopson, & Stansel, 2018). The law treats the act of taking payment as a crime. It is wrong for the hospital to ask for payment for training the patients on DME usage since it is their duty. The home health agencies should also conduct free training to patients on the usage of DME like clutches and walkers. Therefore, I would advise the subsidiary personnel against paying the agency and hospital for patient training on the usage of DME. Secondly, I would caution caregivers against accepting or asking for payment from the subsidiary. The fourth concern is that DME may have “massaged a bit” the test results to facilitate Medicare payment for oxygen concentration. To “massage” the test results is to ‘doctor’ them to suit the needs of the patients. The act of providing false results to the patients is against the healthcare laws and the well-being of the patients. Providing false results can tarnish the reputation of the health facility (Ducharme, Bernhardt, Padula, & Adams, 2017). The government can also order for the closure of the subsidiary and the entire Marcus Welby Healthcare Corporation. The unlawful act can also prematurely end the careers of the salesmen. However, the worst implication of “massaging” findings is that it can endanger the lives of the clients. Therefore, I would advise the caregivers against providing incorrect results to the patients. The caregivers should offer true results at all time. Conclusion: The salesmen should not offer ‘premiums’ to health agencies; since the act is against the health laws. Payment for referrals is a criminal offense. The health provisions also inhibit caregivers from offering ‘rebates’ to patients to earn their loyalty. The subsidiary should not pay any DME training fees to hospitals or health agencies. The issuance of ‘doctored’ results can tarnish the reputation of the health facility and the caregivers. References: Clemente, S., McGrady, R., Repass, R., Paul III, D. P., & Coustasse, A. (2018). Medicare and the affordable care act: fraud control efforts and results. International Journal of Healthcare Management, 11(4), 356-362. Ducharme, M. P., Bernhardt, J. M., Padula, C. A., & Adams, J. M. (2017). Leader Influence, the professional practice environment, and nurse engagement in essential nursing practice. Journal of Nursing Administration, 47(7/8), 367-375. Fabrikant, R., Kalb, P. E., Bucy, P. H., Hopson, M. D., & Stansel, J. C. (2018). Health care fraud: enforcement and compliance. Law Journal Press. Ghebleh, S. (2017). No VIP treatment: ACOs should not get waiver protection from the prohibition on beneficiary inducement. Vand. L. Rev., 70, 737. Pena, J. A., Larson, J. C., & O’Connor-Barnes, E. (2016). Parallel Investigations and Prosecutions in Anti-Kickback Cases Involving Healthcare Providers. US Att’ys Bull., 64, 47. Stowell, N. F., Schmidt, M., & Wadlinger, N. (2018). Healthcare fraud under the microscope: improving its prevention. Journal of Financial Crime, (just-accepted), 00-00.

COM 410 Healthcare Regulatory Environment

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