A healthcare fraud conspiracy in Philadelphia between 2005 and 2008 was uncovered. Patricia McGill, a registered nurse, caused a multimillion-dollar fraud on Medicare by authorizing and supervising the admission of inappropriate and ineligible patients for hospice services. Patricia, alongside four other defendants, were arrested on several counts of healthcare fraud and one count of conspiracy to commit healthcare fraud. The administrator of the HCH was also indicted separately. If I was the administrator of the hospice and these five nurses worked for me, I would first conduct an internal audit within the workplace to ensure that I realize the fraudulent activity is occurring in the firm. I would ensure that I tried to discover the fraud before the government audit. This would allow me to take significant action to cushion the blow of the nurse's fraudulent activities on the firm. I would also take significant action to reduce the chances of such fraudulent practices surfacing again in the organization.
As the administration of the hospice facility, once I get wind about the employee's fraudulent activities, I would immediately launch an internal investigation. This would be before the government audit to ensure I take control of the situation before it is too late for the organization and the relevant stakeholders. This investigation will be aimed at finding out if, indeed, these nurses were involved in fraudulent actions (Akuh, 2017). I will not first confront them, as this will alert them that I am investigating their actions in the workplace. Moreover, I would not want to accuse them of something serious such as committing fraud without having proof. However, I would suspend the nurses during the investigation to avoid them interfering with the process (Omar, Nawawi, & Salin, 2016). I will then collect the necessary information and build the case against the guilty individuals.
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After realizing the existing fraudulent activities, I will then call the nurses one by one to my office. Here I will confront each one of them on the issue at hand. I will let them know that they have been indulging in fraudulent activities within the organization (Akuh, 2017). I will then let them explain their situation. If they refused, I would let them know that there was evidence of their participation in the act. I will then ask them to name all those they indulged in the fraud activities with and ensure that they know their refusal to cooperate would only harm the innocent employees and the firm. I would want to understand the motivation behind the act to protect the firm from future fraud (Omar, Nawawi, & Salin, 2016). I would then inform them that they are terminated since giving them a second chance would probably lead to a repetition of the offense. I would terminate all the five nurses and other employees who were aware of the fraudulent activities and did not speak up.
After terminating the nurses, I would then address the issue with the remaining workforce to remove any existing propaganda. I would inform them of what their fellow employees were doing to ensure the remaining employees are aware of the consequences of such actions (Akuh, 2017). I would then take the corrective steps to recover the lost money. Here, I would proceed to inform the local law enforcement authorities on the fraudulent activities of the terminated employees (Akuh, 2017). I will also start legal action against these nurses since the cost of their activities amounted to $9.32 million. This is a significant amount that will negatively affect the organization. Starting legal action on the employees will ensure that the employees take responsibility for their actions (Omar, Nawawi, & Salin, 2016). It will also ensure that other employees do not indulge in such activities as they will witness the effects of such fraudulent activities.
To prevent future fraudulent activities from staff members, I would take the following actions. First, I would create a system within the organization that runs background checks on any potential employees (Omar, Nawawi, & Salin, 2016). The background checks will flag out employees who are likely to commit fraud, thus ensuring they do not get employed. I would also ensure that I have a vested interest in the employees to see their behavior and identify potential fraud risks (Akuh, 2017). I would also institute a fraud risk policy and ensure the employees are well educated on it. I will then create a safe space for employees to offer tips on ongoing or potentially fraudulent activity in the organization (Omar, Nawawi, & Salin, 2016). I would also ensure that within the organization, internal control programs are revised and monitored on a regular and consistent basis to flag off any inconsistencies, thus alerting the management of any suspicious activities.
I will also ensure that the employees are educated on the importance of displaying ethical behavior in the workplace. I will then try to mitigate the factors that made it possible for the nurses to take part in the fraudulent activities within the hospice (Omar, Nawawi, & Salin, 2016). I will also ask that a program be created for hospice patients to ensure they are well educated and do not find themselves taking part in fraudulent activities. I would also hire new trustworthy experts who will oversee the organizations' accounts (Omar, Nawawi, & Salin, 2016). I will ensure that the firm has certified fraud examiners and certified public accountants who are certified in fraud forensics. This ensures that I mitigate the instances of fraud in the organization.
All organizations are susceptible to having fraud cases. These activities are facilitated by numerous known reasons that can easily affect the profitability and credibility of the organization. Any suspicion of fraud must first be investigated before taking appropriate actions. Employees who commit fraud must be terminated to reduce the chances of having to deal with similar issues. Running background checks, sensitizing employees and patients, and having trustworthy employees are some of the critical ways one can instill in their organization to reduce fraudulent activities in the firm.
References
Akuh, C. G. (2017). Small retail business strategies to detect and prevent employee fraud. https://scholarworks.waldenu.edu/cgi/viewcontent.cgi?article=5369&context=dissertations
Omar, M., Nawawi, A., & Salin, A. S. A. P. (2016). The causes, impact, and prevention of employee fraud. Journal of Financial Crime . https://sci-hub.tw/https://doi.org/10.1108/JFC-04-2015-0020
