Medicaid Fraud Medicaid Fraud

Research Question: Could the costs associated with Medicare fraud
decrease the quality of care for the elderly.
Research Problem
According to Aldrich & Benson (2012), Medicaid improper payments are
highly prevalent and it is estimated to have been $64 billion in the
2011 fiscal year. Even so, it is believed that the levels of fraud
recorded are not completely quantized and therefore the levels of
Medicaid fraud could be higher than those reported (Aldrich & Benson,
2012). While some of the improper payments do not pass as fraud, these
scholars stated that fraud accounts for a significant percentage of the
same amounting to billions of dollars. The Department of Health and
Human Services (2012) stated that one of the outcomes of Medicaid fraud
is reduced quality of care. According to the WHO (2006, p. 9 &10),
quality of care refers to extent to which healthcare services are
“effective, efficient, accessible, acceptable/patient centered,
equitable and safe”. This means that money which could have been used
to purchase equipment and improve care is not used for the same. Care
for the elderly is important because they currently constitute a
significant portion of the population. A reduction in the financial
accountability affects quality of care because according to Rose (2006)
and Lewis (1989), the collaborative effort needed to care for the
elderly cannot be achieved without proper financing and elimination of
insurance fraud. Nevertheless, this relationship has not been fully
explored through research.
Brief Review of Literature
Overview of Medicaid services for the elderly.
Benefits of Medicaid for the elderly.
Potential reasons for fraud in Medicaid.
Effects of Medicaid fraud on the quality of care for the elderly.
Potential effects of Medicaid fraud on elderly patient outcomes.
Brief Description of Method
Research Design – Qualitative Study – Two research instruments
including interviews and questionnaires both with open ended questions.
Participants and Participant Sampling – 20 nurses in Elder care homes
– Random sampling of nurses.
Procedure – Questionnaires will be sent though the email to all
participants. The participants will need 30 to 45 minutes to complete
them. The interviews will involve 50% of the participants and they will
be conducted via the telephone and will last for 15 to 20 minutes.
Data analysis – Coding
Limitations of the study – Small sample from three elder care
facilities which limits transferability.
Research Ethics – consent, no ill treatment of participants,
confidentiality, confining data use to intended purpose, careful data
storage.
Brief Discussion of Potential Implication of the Study
Development of policy that will increase accountability in Medicaid
funds usage.
Development of stricter punishment for perpetrators of Medicaid fraud.
Improved quality of care for the elderly due to reduced fraud.
References
Aldrich, N. & Benson, B. (2012). Medicare/Medicaid improper payments
exceed $64 billion a year: Fraud estimates more difficult to estimate.
The Sentinel. Retrieved September 13, 2013, from HYPERLINK
“http://www.smpresource.org/docs/The_Sentinel_May2012_HBABCs_Fraud_Estim
ates.p”
http://www.smpresource.org/docs/The_Sentinel_May2012_HBABCs_Fraud_Estima
tes.p df
Department of Health and Human Services. (2012). Medicare fraud & abuse:
Prevention, detection, and reporting. Retrieved September 13, 2013,
from HYPERLINK
“http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-
MLN/MLNProducts/downloads/Fraud_and_Abuse.pdf”
http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-
MLN/MLNProducts/downloads/Fraud_and_Abuse.pdf
Lewis, C. S. (1989). Elder care in occupational therapy. New Jersey:
Slack.
Rose, K. (2006). Elder care: A responsibility that requires a
collaborative effort. Retrieved September 13, 2013, from
http://www.awlp.org/pub/nwfm_Elder_Care_Collaborative_Effort.pdf
WHO (2006). Quality of care: A process for making strategic choices in
health systems. WHO: Geneva. Retrieved September 13, 2013, from
http://www.who.int/management/quality/assurance/QualityCare_B.Def.pdf
MEDICAID FRAUD PAGE * MERGEFORMAT 4
MEDICAID FRAUD PAGE * MERGEFORMAT 1

Close Menu