Week 9 Case Study - Healthcare Quality

Overview

In order to complete this case study, refer to this week’s readings for policy information required to analyze and make recommendations on this case.

As a healthcare quality fraud analyst, you are responsible for identification of root causes and providing recommendations in an action plan to ensure compliance with federal and state quality policies.

Instructions

Read the Department of Justice story, “South Jersey Doctor Charged in Health Care Fraud Billing Scheme.” Then, write a 1–2 page report in which you:

1. Summarize three quality issues in the case that resulted in fraudulent billing and coding.
2. Describe three violations that were stated in the case, including how the violations applied based on regulations.
3. Illustrate how this case could be used as a training tool for your organization. You may base your work on the Department of Health and Human Services Office of Inspector General (DHHS-OIG), the Center for Medicare and Medicaid Services (CMS), and the Department of Justice (DOJ) information on quality, fraudulent billing, and so on.