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Saturday, 24 May 2014 14:16

Tenet Healthcare Foundation Featured

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Tenet Healthcare Foundation


 The issue of medical fraud is massively sensitive towards the provision of quality health care services across the country. Within the framework of this research, the fraudulent billing detected at the Tenet Healthcare Foundation is the main issue of analysis in terms of medical fraud. Based on the immense significance of this analytical framework, it is pertinent to evaluate the most effective theoretical perspectives that are aligned to the issue of medical billing fraud. In view of this perspective, the fraud management lifecycle theory will be the fundamental theoretical framework. This theory is massively essential in terms of dissecting the pertinent issue of medical billing fraud. It provides excellent elements for addressing the extensive challenge of medical billing fraud even from the perspective of the Tenet Healthcare Foundation. In addition to an evaluation of the theoretical foundation, the analysis includes an elucidation of the main research question of the study.


 Theoretical Foundation

The fraud management lifecycle theory is the core of the entire research. In essence, this theory provides an exceptional platform for a systematic evaluation of the issue of medical billing fraud. This theory has essential components or elements which may be integrated into the analytical framework of medical fraud at the Tenet Healthcare Foundation. This theory can be integrated into the issue of medical billing fraud based on eight stages. The first phase based on this theory is deterrence (Baker & Baker, 2010). During this stage, the theory emphasizes on the need to strategize and implement adequate mechanisms for averting potential fraud.At the Tenet Healthcare Foundation, numerous platforms of deterrence were available. These mechanisms would have been massively beneficial in terms of averting medical fraud even before it had rocked the organization. The second stage within the framework of this theoretical mechanism is the prevention stage.


In this stage of the theory, immense emphasis is placed on the establishment of the relevant avenues for protecting an organization from any fraudulent actions. While the preventive and deterrence stages are different, they can be combined especially if an organization is experiencing one or more constraints in terms of resources (Baker & Baker, 2010). When an organization has sufficient platforms for preventing fraud, extensive resources can be protected. The third pertinent stage of this theory involves detection. This is a pertinent phase that involves the accurate identification of potential threats of fraud. It is massively essential to enhance the accuracy levels of the detection system.


High levels of accuracy facilitate for the relevant interventional strategies. In contrast, the absence of the relevant mechanism of accuracy contributes negatively towards the efficiency of the chosen intervention.Detection occurs when the previous two stages have not been implemented accordingly. This perspective is an indicator that the detection stage occurs when there in an element of fraud within the organizational system. It is massively essential for an organization like the Tenet Healthcare Foundation to have an effective framework for detection. For instance, early detection facilitates for adequate intervention for the fraud (Baker & Baker, 2010).


Mitigation is the next phase within the framework of the fraud management lifecycle theory. The mitigation phase is focused on the reduction or stoppage of the different causative factors for fraud. Mitigation is also essential in that it prevents an escalation of the fraud in an organization.The next stage involves analysis. This stage zeros in on a comprehensive evaluation fraud in terms of the causative attributes, the responsible employees, and implications on organizational performance. For instance, analysis would have helped in determining the actual ramifications of fraud on the organizational performance of Tenet Healthcare Foundation.


The next phase involves policy. This is vital in terms of changing the overall legal framework and administrative mechanisms used by an organization. Investigation is the penultimate stage of the theory. It caters for the determination of the liable employees and the extent of fraud. Prosecution is the final stage of the theory. Excellent standards of balance in the different eight phases are massively pertinent in fraud management in health care organizations such as the Tenet Healthcare Foundation (Baker & Baker, 2010). The theory has been widely integrated into the interventional framework for fraud across numerous organizations.


 Research Question

What strategies can be used to prevent medical billing fraud at the Tenet Healthcare Foundation?

This research question is highly extensive since it involves numerous variables. Firstly, the question will greatly bolster the mechanism of evaluating the different causative factors of medical billing fraud. The second aspect involves the evaluation of the implications of fraud on an organization like the Tenet Healthcare Foundation. Additionally, this research question will help in determining the efficiency of different interventional measures.


 Conclusion

The analysis provides an excellent theoretical foundation of the issue of medical billing fraud. The fraud management lifecycle theory has been identified as an essential basis of the research. The different stages of this theory can be integrated into the preventive blueprint of fraud at any health care organization. The analysis has also provided an overview of the research question. The question is vital in that it involves an evaluation of numerous variables on the issue of medical billing fraud.


 References

Baker, J. J., & Baker, R. W. (2010). Health Care Finance: Basic Tools for Nonfinancial Managers. Boston, MA: Jones and Bartlett Publishers.


 

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