Fraud and Abuse; Incorrect Billing Practices

Other important legal considerations within health care fraud and abuse include the following laws and statutes:

Federal False Claims Act.
Anti-Kickback Statute.
Physician Self-Referral Law.
Criminal Health Care Fraud Statute.
Exclusion Statute.
Civil Monetary Penalties Law.

Don't use plagiarized sources. Get Your Custom Essay on
Fraud and Abuse; Incorrect Billing Practices
Get an essay WRITTEN FOR YOU, Plagiarism free, and by an EXPERT!
Order Essay

Some of these involve related or overlapping areas.

This point in your health care administration career is an ideal time to deepen your knowledge and skills related to common fraud and abuse areas. You may wish to develop a short list of legal topics to assist in ongoing future monitoring workplace activities. It is important to include the associated authoritative governmental websites in your topic list.

In this assignment, you will assume the role of an early careerist in risk management and quality improvement at one of Vila Health’s community-based hospitals. Vila Health is a medium-sized system of health operating facilities in Minnesota and Wisconsin. You have been tasked with constructing a workplace brief for recommendations about identification of and interventions to address incorrect health care billing practices. In this case, upcoding is the incorrect billing practice that is the focus of the chief compliance officer. Your workplace brief will be used to influence future policy and procedure content for billing practices, including the incorrect practice of upcoding.


Assume that you are a member of the chief compliance officer’s team in Vila Health. Recently, an incorrect billing practice known as upcoding has been discovered. Upcoding is a common area for fraud and abuse, and the recent incident has become a major area of focus for the chief compliance officer.

The chief compliance officer has tasked you with researching and making evidence-based recommendations about how to identify and address this incorrect billing practice. Your recommendations will be considered for possible inclusion in future policy and procedure content.

The chief compliance officer has stressed with you the importance of incorporating evidence-based recommendations. She is specifically interested in the Office of Inspector General’s position on upcoding, any relevant case precedents, and any available resources for health care organizations. You know from experience that the workplace brief will need to include substantiation of all facts and recommendations from authoritative sources. The team leader has asked you to cover all of the following headings in your brief.

Use the Identifying and Addressing Upcoding Template given in the resources to write your brief.

Major Categories of Health Care Fraud and Abuse

In one page:

Describe the major categories of health care fraud and abuse.
Be sure to include the billing practice known as upcoding.
Five Health Care Fraud and Abuse Laws

In two pages:

Provide a synopsis of five laws relating to health care fraud and abuse.
Include the rationale for why you selected the laws you did.
Upcoding and the Law

In one to two pages:

Explain in detail one law pertaining to upcoding.
Be sure to explain how the law specifically applies to upcoding.
Provide actual examples of upcoding.
Select your examples from the assigned readings, from research you conducted on the topic, or from your professional experience. If your examples stem from your professional experience, please be sure to protect individual and organizational identities.
Evidence-Based Recommendations to Address Upcoding

In one to two pages:

Propose a list of evidence-based recommendations to identify and address upcoding in the health care environment.
Be sure to consider in your recommendations what the Office of Inspector General has to say about identifying and addressing upcoding.

Tip: Review the following from the unit readings:

Avoiding Medicare Fraud and Abuse.
Compliance Resources.
Additional Requirements

Your assignment should meet the following requirements:

Written communication: Use the Identifying and Addressing Upcoding Template given in the resources. Ensure your workplace brief is clear, succinct, well organized, and free of errors in grammar, punctuation, and spelling.
Length: 5–7 single-spaced pages, including the reference page.
Font and font size: Times New Roman, 12 point.
Title page: Develop a descriptive title of 5–15 words. It should stir interest yet maintain professional decorum. Ensure that your title page conforms to current APA format.
References: Include a minimum of six current (within the past 5 years), authoritative citations in current APA format. Include a separate reference page that conforms to APA guidelines.

Review the Fraud and Abuse: Incorrect Billing Practices Scoring Guide so that you understand how your faculty member is going to evaluate your work. Submit your assignment as a Word document.

Homework Sharks
Order NOW For A 10% Discount!
Pages (550 words)
Approximate price: -

Our Advantages

Plagiarism Free Papers

All our papers are original and written from scratch. We will email you a plagiarism report alongside your completed paper once done.

Free Revisions

All papers are submitted ahead of time. We do this to allow you time to point out any area you would need revision on, and help you for free.


A title page preceeds all your paper content. Here, you put all your personal information and this we give out for free.


Without a reference/bibliography page, any academic paper is incomplete and doesnt qualify for grading. We also offer this for free.

Originality & Security

At Homework Sharks, we take confidentiality seriously and all your personal information is stored safely and do not share it with third parties for any reasons whatsoever. Our work is original and we send plagiarism reports alongside every paper.

24/7 Customer Support

Our agents are online 24/7. Feel free to contact us through email or talk to our live agents.

Try it now!

Calculate the price of your order

We'll send you the first draft for approval by at
Total price:

How it works?

Follow these simple steps to get your paper done

Place your order

Fill in the order form and provide all details of your assignment.

Proceed with the payment

Choose the payment system that suits you most.

Receive the final file

Once your paper is ready, we will email it to you.

Our Services

We work around the clock to see best customer experience.


Flexible Pricing

Our prces are pocket friendly and you can do partial payments. When that is not enough, we have a free enquiry service.


Admission help & Client-Writer Contact

When you need to elaborate something further to your writer, we provide that button.


Paper Submission

We take deadlines seriously and our papers are submitted ahead of time. We are happy to assist you in case of any adjustments needed.


Customer Feedback

Your feedback, good or bad is of great concern to us and we take it very seriously. We are, therefore, constantly adjusting our policies to ensure best customer/writer experience.