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The funding and reimbursement aspects of health care delivery

The funding and reimbursement aspects of health care delivery are complicated, transaction-oriented, and subject to applicable laws and regulations. The sheer volume of transactions and myriad nuances of patient care make the process of documenting services delivered and payments received even more complex. Unfortunately, motive and opportunity to commit fraud often find health care organizations an ideal target for criminal activities given this volume of complex transactions.

You have been retained as a consultant by a large health care organization that wants to take a proactive approach to fraud prevention by increasing employee awareness. They have asked you to provide a report outlining how you would develop a training program for managers that will help them learn to do the following:

Analyze health care fraud and the consequences of health care fraud on the following:
Patient
Health care provider
Institutions involved
Others
Assess the concerns of a manager pertaining to the receipt of payment for services rendered.
Evaluate the impact of payments or delays in payment on budgeting and planning.

 

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