Three quality issues
The three quality issues that resulted in fraudulent billing and coding is the fact that the accused operated many clinics, which made it possible to perpetrate the ills through the various clinics.
The three quality issues that resulted in fraudulent billing and coding is the fact that the accused operated many clinics, which made it possible to perpetrate the ills through the various clinics.
Another quality issue is that the government through the health department was not lenient and did not carry out proper audits as it would have realized the anomalies before it was too late.
Finally, the regulatory bodies were lenient because clinician ought to have limits on the use of Medicare, Medicaid and insurance. For instance, there should be a set amount beyond which the clinician could not charge because of the level of the clinic.
Three violations
The three violations highlighted in the case are upcoding where the accused billed for a more expensive service than the patient actually receive.
Three violations
The three violations highlighted in the case are upcoding where the accused billed for a more expensive service than the patient actually receive.
The case also reveals phantom billing whereby Antebi committed the fraud of billing for a service that the patient never received. It is indicated in the case that Antebi left the clinic early, yet it was billed as though he saw many patients.
Antebi was also involved in double billing whereby multiple claims were submitted for the same service by billing the service on Medicaid and Medicare.
Use of the case for training
The case on south jersey could be used as a training tool in the organization on fraudulent billing because it is the most likely and the most prevalent form of fraud. Healthcare providers can either independently engage in double billing, phantom billing, unbundling and upcoding because they need to increase their bottom-line, and the patient might not be informed about such malpractices (FBI, 1).
Use of the case for training
The case on south jersey could be used as a training tool in the organization on fraudulent billing because it is the most likely and the most prevalent form of fraud. Healthcare providers can either independently engage in double billing, phantom billing, unbundling and upcoding because they need to increase their bottom-line, and the patient might not be informed about such malpractices (FBI, 1).
It is normally held that information is power, and medical providers understand that patients are unaware about such details like billing, thus take advantage of such “ignorance” to practice fraud. The issue of fraudulent billing can also help the organization to explore its internal control systems and identify areas of susceptibility.
