2 Oct 2022

56

Stakeholder Analysis: Medical Insurance Fraud

Format: APA

Academic level: Master’s

Paper type: Assignment

Words: 1463

Pages: 5

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Argumentation Analysis 

The Frustration of Robocalls 

The argument behind the article on robocalls suggests that the automated calls are very annoying as the majority of Americans receive several of them in a day. As much as the calls are annoying, there is nothing much that anyone can do as the perpetrators are within the law ( Blanco, 2019) . Numerous relevant services rely on the robocalls such as physicians’ calls that remind patients on appointment dates or test results. As much as the spam calls are nuisances, but again some are within the law, making it difficult to avoid them. The robocalls are an irritation because many telemarketers use them to reach a broader market cost-effectively. 

There is a need to make these automated robot calls illegal as statistics indicate that in 2018 alone; more than 48 billion robocalls were made. These autodialed calls from unidentified persons are a frustration to the majority of Americans and thus should be outlawed ( Pal, 2017) . Technological advances have simplified marketing making it possible for an individual by use of the Voice Over Internet Protocol, autodial more than a thousand numbers within seconds. There is no technical expertise necessary for making the cheap calls, and the method provides access to not only the US market but also the global market. 

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The cunning robocallers have ensured that they are ahead of telephone companies and the government in their efforts to thwart their endeavors. Additionally, criminals have taken advantage of the trends and have call centers established abroad complicating the government’s ability to end their illegal operations ( Pal, 2017) . Many of the telephone companies' clients are annoyed with the anonymous auto-dialed calls. Moreover, the government is helpless as the law cannot entirely prevent the use of the services as there are several exemptions such as callers with informational messages and charities. Therefore, the solution to these annoying and frustrating phone calls that is no longer made to landlines but also to mobile phones is for the telephone companies to innovate software that will enable people to identify the scam calls. 

Children’s Civic Duties 

Children lack the necessary resources that will connect them with subjects related to civics and government. The dynamic world exposes them to more entertainment than political and thus the kids cannot link to any issues that concern the development of their government. But, the primary cause is the lack of sufficient lessons in school to teach the young one's civics ( Pfaff, 2018) . The children lack common knowledge because most schools have reduced or replaced the number of lessons with more mathematics or reading lessons. Additionally, their parents have also withdrawn from participating in elections; hence the kids lack role models in the subject. 

Schools have stopped or decreased civic lessons because of the No Child Left Behind Act, an education policy that requires all children to access equal learning opportunities. Teachers are thus, forced to reduce lessons from subjects that have little or no significance such as civics and government. Currently, there is an alarming increase in civic disengagement as more young people are interested in participating in public activities such as voting ( Sondel, 2015) . This disengagement poses a significant challenge to the future civic prosperity of the nation. The waning interest on the significance of citizenship could lead to exceptional difficulties that range from global warming to a detonation of costs of healthcare to name but a few consequences. 

Formerly, civics lessons were taught for an entire high school year, but of late the lessons take a maximum of a semester in some institutions while others do not explain it thoroughly. In the overhyped presidential elections held in 2008, a mere 49 percent of youth aged between 18 and 24 years old voted while the majority of the voters were adults aged between 45 and 74 years old. Similar trends were noted in the successive Donald Trump elections. The youth will continue to be ignorant of their civic responsibilities. Additionally, the schools are of no help as much emphasis is in subjects that are more biased into making the child adept at reading and mathematics ( Dung, 2016) . Likewise, their parents are not aware of how they could participate in enlighten their children on their civic responsibilities. Therefore, the kids’ political education should start right away with kids of all ages. 

The most plausible arguments include the telephone companies protecting their clients from the robocallers and starting civic education right away. By innovating the software that would identify the scam calls, the companies will not only reinstall the confidence in their users as the auto-dials are a reason for to increase stressed levels. The earlier civic education is started, the earlier the kids will be familiar with the rights and responsibilities to the society and the nation in general. 

Stakeholders in Medical Insurance Fraud 

Doctors, nurses, and technicians are not the only stakeholders in the fraud that has cost the United States billions of taxpayers’ money. Stakeholders also include healthcare providers with some identified as big-time fraudsters in the nationwide scam. The Department of Health and Human Services, Office of the United States Attorney, the Department of Justice, the Secret Service of the United States, Department of Inspector General are government agencies that have collaborated in forming a task force in charge of investigating and prosecuting case related to medical healthcare fraud ( The Department of Health and Human Services & The Department of Justice, 2006) . To end the list of the stakeholders are the patients, their families, legislators, and subordinate staff in health institutions. 

In prioritizing the stakeholders, mapping was done based on the level of interest and powers the stakeholders have concerning the subject. Thus, four categories were identified, and they include; 

Stakeholders with high power and have a high interest in medical insurance fraud comprise; 

i) The Department of Health and Human Services 

ii) Office of the United States Attorney 

iii) The Department of Justice 

iv) The Secret Service of the United States 

v) Department of Inspector General 

With this category, they need close management, and this can be achieved by putting great efforts at impressing and satisfying them. 

Stakeholders with high power but who are less interested in the medical scandal include the legislators. The legislators can be handled best by putting a lot of work to ensure that they are satisfied, but again the messages sent to these lawmakers should be of quality to avoid wearing them. 

The doctors, nurses, technicians, and patients are stakeholders who are classified as having low power but, are highly interested in medical insurance fraud. This category can be managed best by keeping them informed and continually talking to them to guarantee that no unplanned issues suffice. 

Patients’ family members and subordinate staff n health institutions are the last groups that have low interest in the subject matter and low power over decisions pertaining to the same. This group can be managed best by monitoring without burdening them with uncalled for information. 

Number Ideas collected from Different Stakeholders 

3 3 1 2 1 

1 1 1 1 0 

0 0 0 0 0 

Number of Ideas 

Relative Frequency 

Cumulative Relative Frequency 

     

0.27 

0.27 

0.40 

0.67 

0.07 

0.74 

0.13 

1.04 

Ideas Generated 

The government agencies had excellent views as they advised on not receiving phone calls from people strangers as the new medical scheme involved companies calling randomly to provide low-quality knee and back braces that they claim are free but are later billed on Medicare. Another idea also came to inform of advice to patients who required the braces to get in touch with their doctors and not strangers ( Leventon et al., 2016) . Additionally, they suggested that people should not entrust strangers with confidential details such as a social security number for whatever reason. 

Legislators were also impressive as they suggested the formulation of policies that would bar perpetrators of the fraud from providing healthcare services as a way to deter healthcare providers from engaging in corrupt practices. They further suggested that policies should be formulated to revoke the licenses of practicing physicians caught in fraudulent acts. Severe punishments would reduce immensely the number of fraudulent cases ( Leventon et al., 2016) . The doctors, technicians, nurses, and the patients on their part suggested that civic education be carried out to enlighten the masses as the majority of people had no knowledge of how the scams were carried out. The subordinate staff and the relatives to patients had no new ideas and echoed what the other groups had suggested. 

As the stakeholders were undergoing interrogation in the form of interview questions, the ideas were coming out profusely but after engagement with 15 stakeholders their seemed to be lack of new ideas. When plotted graphically, the graph would be said to flatten after the first 15 stakeholders. Most of the respondents focused on blaming the other groups for the escalating medical fraud but all in all it was apparent that there were loopholes in the policies that allowed for the fraudsters to use ( The Department of Health and Human Services & The Department of Justice, 2006) . The fraudsters were devising new ways of fraudulently obtaining money taxpayers money from medical insurance companies thus imperative that government agencies keep up with their trends. 

References 

Blanco, O. (2019, April 4). Mad About Robocalls? Retrieved April 29, 2019, from https://www.consumerreports.org/robocalls/mad-about-robocalls/ 

Dung, P. M. (2016). An axiomatic analysis of structured argumentation with priorities.  Artificial Intelligence 231 , 107-150. 

Leventon, J., Fleskens, L., Claringbould, H., Schwilch, G., & Hessel, R. (2016). An applied methodology for stakeholder identification in transdisciplinary research.  Sustainability science 11 (5), 763-775. 

Pal, M. (2017). Canadian Election Administration on Trial:‘Robocalls’, Opitz and Disputed Elections in the Courts.  King's Law Journal 28 (2), 324-342. 

Pfaff, L. G. (2018, July 26). Raise a Good Citizen. Retrieved April 30, 2019, from https://www.parents.com/kids/responsibility/teaching/raise-a-good-citizen-teaching-civic-values/ 

Sondel, B. (2015). Raising citizens or raising test scores? Teach for America,“no excuses” charters, and the development of the neoliberal citizen.  Theory & Research in Social Education 43 (3), 289-313. 

The Department of Health and Human Services & The Department of Justice, (2006). Health Care Fraud and Abuse Control Program Health Annual Report For FY 2005 -OIG .HHS .gov https://oig.hhs.gov/publications/docs/hcfac/hcfacreport2005.pdf 

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