W7 Legal Discussion Essay Example | Topics and Well Written Essays - 500 words

W7 Legal Discussion - Essay Example Over the years, different interventions have been used in stopping this situation, including the use of criminal fines and sanctions for offenders. It is however debated in this paper that such criminal fines and sanctions are not severe enough to prevent health care fraud. King (2012) outlined different forms of health care fraud that are recorded in various health institutions throughout the country. An important point that King (2012) made while listing the forms of frauds was that as much as the fraud cost the country several billions of dollars year in and year out, the frauds are also very difficult to detect. What this means is that in a situation where there are not very deterring measures to discourage people from engaging in these frauds, they will continue to do them because of the idea that they will hardly be caught in their crimes. In the administration of health care also, prevention has always been noted to be the best way out to dealing with most administrative and clinical issues that come up (Stuart Showalter, 2011). With this said, it is important that there will be stiffer punishment to offenders such that those who have not been involved in these acts of fraud will have no motivation of engaging in them (Morris, 2009). Fraud and for that matter crime is an issue that works on a cost-benefit basis. This means that when people have a feeling that by engaging in crime, they get better benefits than what they suffer as a result of being caught, they are likely to repeat their actions. Even if those involved do not repeat their actions, those who have not been involved will have no deterrent not to be involved in it. To this end, it is important to take a new approach to preventing providers and organizations from engaging in health care fraud. From a very pragmatic perspective, it is recommended that offender who are found should have their licenses of

Pharmaceutical Industry Research Paper Example | Topics and Well Written Essays - 500 words

Pharmaceutical Industry - Research Paper Example Insurance companies work by charging a premium for people to use their service, this premium is often paid in part by employers. To reduce their personal risk, insurance companies spread their services over a large group of people. As a consequence, the insurer receives premiums for taking on the risk for the people that it insures, and calculates the number of people in the group such that any losses are covered by the premiums paid by the rest of the group (Casto & Layman, 2006). Medicare works in a similar way, and is so effective as a business model, that private insurance firms base their models off that of Medicare (Bodenheimer et al., 2002). Medicare is a reimbursement system used in hospitals in the United States. It is large, with spending totaling over $11.7 billion in 1999 (Cotterill & Gage, 2002). Medicare is a form of insurance, using contributions from both employers and employees to make part of the premium for individual coverage. In addition, some individuals who do not have health insurance benefits through their jobs pay a direct Medicare premium which is then matched by the government (Casto & Layman, 2006).Payments from Medicare to hospitals are dependent on the number of patients that are being admitted to the hospital (Bodenheimer et al., 2002). Medicare works to provide reimbursement for costs such as per diem fees, but doesn’t take care of start up costs, some physician costs, and there are no bonuses in Medicare subsidies for superior care. From a health care perspective this means that any increase in care comes at the hospitals own cost, and is not reimbursed, and that the best financia l results come from decisions that result in lower health care (Bodenheimer et al., 2002). An important part of determining how to best treat patients is to look at the costs versus level of care. One example of this kind of decision is the instigation of a program that reduces hospital admissions in