As a health administrator, I will institute an elaborate procedure to address the issue facing my hospital. Notably, the procedure will comprise several steps, each of which will be aimed at achieving a specific objective. Key objectives of the procedure include restoring the public’s trust in the institution, calming the media frenzy and addressing the concerns raised by media outlets, developing a cogent response to the lawsuit, and ensuring that the incidences and practices do not happen again. To deal with the media, I will commence by holding a press conference where I will endeavor to address the primary concerns in the public domain. Throughout the press conference, I will not try to conceal the truth but rather, I will seek to set the record straight. Besides, the press conference will entail answering the questions raised by the media. In essence, this will be the first step towards the restoration of the public's trust. The next key step of the procedure will entail dealing with staff. To deal with staff, I will form a team that will be tasked with evaluating the past practices of physicians, particularly concerning referrals. Notably, the evaluation will entail determining whether the physicians have a financial connection or interest in the hospitals where they referred patients. Culpable physicians will then be subject to disciplinary action that will range from surcharges to outright dismissal from my healthcare institution.
To ensure that the practices and actions that led to the lawsuit do not happen again, I will take wide-ranging preventive measures. First, I will seek to determine the specific charges that contributed to the overbilling of Medicare by millions of dollars over several years. Derlet et al. (2016) assert that falsely inflated emergency department charges make up a leading contributor of overbilled Medicare in healthcare institutions. Moreover, managerial staff, emergency physicians, and administrative staff are predominantly responsible for the falsification of emergency department charges (Derlet et al., 2016). As such, a key preventative measure that I will seek to take is the installation of an electronic billing system. The system will be predominantly predicated on front-end analytics. Drabiak and Wolfson (2020) posit that front-end analytics helps address egregious fraud in healthcare provision by automatically flagging outliers in billing systems. In essence, the system will curtail the falsification of medical charges by ensuring that the charges correspond to the services rendered. As part of the preventive measures, I will also seek to establish whether the professional fees charged by physicians contributed to the overbilling of Medicare. Derlet et al. (2016) observe that the billing of professional fees and hospital charges is often separate and as a consequence, this paves the way for financial impropriety. This is particularly so for profit-oriented healthcare organizations where professional fees are inflated to attain optimal profits (Derlet et al., 2016). Such practices ordinarily imperial both the patient and the taxpayer in instances where the patient is treated under Medicare (Derlet et al., 2016). In a bid to curtail the inflation of professional fees, I will seek to introduce policies that provide for the integration of professional fees and hospital charges. More fundamentally, the policies will place a cap of the maximum billable professional fees for any patient admitted to my healthcare institution. In addition, the policies will outline the criteria for charging professional fees. In essence, the criteria will be predicated on a raft of factors, key among them being the patient’s diagnosis, as well as their medical history. Lastly, the preventive measures aimed at addressing the issue of overbilling will seek to determine whether unnecessary admissions, laboratory and imaging tests were a major cause of the overbilled Medicare. Derlet et al. (2016) posits that healthcare institutions that utilize emergency department software programs often subject patients to a vast array of unnecessary imaging, as well as admissions tests even before the patients are examined by a physician. Such practices often result in ballooning costs and overbilling for patients. As a preventative measure, I will seek to introduce guidelines that set out preconditions for carrying out specific tests on patients. Moreover, the guidelines will stipulate that the patients have to be examined by a physician before being subjected to any kind of tests. This measure will ensure that only physicians will have the authority to recommend tests and consequently reduce the number of unwarranted admissions, laboratory tests, as well as imaging tests.
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To address the issue relating to the violation of the Stark law, I will take a raft of actions. To begin with, I will endeavor to inculcate a culture of transparency and accountability across the entire institution. Weissman (2016) asserts that transparency is an indispensable element of healthcare provision primarily because it helps reduce professional malpractice. By adopting culture transparency and accountability, physicians will be predisposed to engage in legal and ethical practices, as opposed to practices that result in the violation of the Stark Act. To ensure that the violation of the Stark Act does not happen again, I will institute a raft of preventive measures. The first key measure will entail setting out the consequences of future violations. Such consequences will include an outright dismissal from the hospital, legal actions against culprit physicians, or even deregistration from professional bodies. In essence, outlining the aforementioned consequences and disciplinarily procedures will serve as a powerful deterrent for engaging in illegal or unethical behavior. The second key preventive measure will include a revision of the institution’s hiring and recruitment procedure. The revised procedure will require prospective physicians to declare and conflicts of interest, as well as their financial interests. This will allow hospital administrators to easily detect incidences of financial impropriety such as those that constitute violations of the Stark Act. The revised procedure will also necessitate prospective physicians to declare, in writing, their commitment to abide by the provisions of the Stark Act. This measure is particularly important because it will see to it that the physician places the interest of the patient over their financial interests. In addition, the measure will ensure patients do not bear unnecessary financial burdens throughout their treatment. The third key measure that will come in handy in preventing future violations of the Stark Act includes an overhaul of policies that guide the induction process for physicians at my hospital. The overhaul will allow for the introduction of policies that necessitate new physicians who join the institution to familiarize themselves will relevant laws and ethical violations that risk placing the entire institution in serious legal jeopardy. This measure is particularly pertinent to the case at hand since the nine physicians who had violated key provisions of the Stark Act may not have been well versed with key provisions of the Act. As such, physicians cannot use ignorance as a defense if they are found to have violated the law throughout their work. The last key measure that will be particularly pivotal to preventing a recurrence of the physicians’ actions will include the creation of an internal disciplinary committee. The committee will be tasked will establishing incidences of financial impropriety well in advance and recommending disciplinary actions against physicians who engage in actions that violate the Stark Act.
References
Derlet, R. W., McNamara, R. M., Plantz, S. H., Organ, M. K., & Richards, J. R. (2016). Corporate and hospital profiteering in emergency medicine: problems of the past, present, and future. The Journal of Emergency Medicine , 50 (6), 902-909.
Drabiak, K., & Wolfson, J. (2020). What Should Health Care Organizations Do to Reduce Billing Fraud and Abuse?. AMA Journal of Ethics , 22 (3), 221-231.
Weissman, S. I. (2016). Remedies for an Epidemic of Medical Provider Price Gouging. FLA. BJ , 90 , 22-24.
