Fraud is rampant in the healthcare industry due to its large size, scope, and complexity. Individuals and organizations have defrauded third-party payers, government agencies, and individuals by fraudulently billing for services not provided and keeping some of the money for themselves. This widespread fraud has stolen billions of taxpayer dollars and prevented some people from receiving needed care. However, federal, state, and local agencies have recovered over $2.5 billion annually through intensified anti-fraud investigations and prosecutions. Healthcare leaders must understand regulations against fraud and establish compliance processes to recognize and address potential fraud situations.

1. Fraud and Abuse in Healthcare
Fraud and Abuse in HealthcareFraud and Abuse in HealthcareFraud is rampant in the
healthcare industry. The size, scope, and complexity of the healthcare industry can attract
individuals and organizations intending to defraud third-party payers, government
agencies, and individuals. This fraud is perpetrated by those looking to access the billions of
dollars available for legitimate medical care to patients needing services at all levels. By
fraudulently billing for services that were not provided, kicking back monies to individuals,
and carrying out other dishonest and unethical practices, individuals have stolen taxpayer
funds and potentially prevented people in need from receiving necessary care. This multi-
billion-dollar fraud has come under increasingly intense investigation, enforcement, and
prosecution by a multitude of federal, state, and local agencies. Through their activities,
billions are being recovered. According to the U.S. Department of Justice, more than $2.5
billion was collected in settlements and judgments from cases involving fraud and false
claims in the healthcare industry during 2016. For the seventh consecutive year, healthcare
fraud recoveries exceeded $2 billion.CLICK HERE TO ORDER YOUR ASSIGNMENTHealthcare
leaders must be familiar with the agencies, regulations, statutes, and practice codes that
impact the delivery of healthcare. Today’s healthcare leaders must understand the
importance of establishing proactive compliance processes and be able to recognize and
address potential situations at risk for fraud and abuse.BY DAY 7 OF WEEK 2This week,
assigned Presenters should post a PowerPoint presentation with a detailed notes section
that contains the following:Incorporation and analysis of the Learning Resources from this
2-week unit, including identification of any apparent gaps in the literatureAn original
research topic related to the week’s literature (the proposed research topic can be related
to the general topic for the week or to gaps in the literature for the week, or it can be related
to a specific reading for the week)Background information on the research topic, including
identification of principal schools of thought, tendencies in the academic literature, or
commonalities that define the academic scholarship regarding your topicEvaluation of the
main concepts with a focus on their application to business/management practice and their
impact on positive social changeA minimum of 10 peer-reviewed, scholarly new
referencesNote: The presentation must be in APA format and must incorporate direct
evidence of addressing the Learning Objectives from this 2-week unit. Each of the content
slides must include detailed notes/paragraphs with appropriate citation of peer-reviewed,
scholarly references.list of resources:Pozgar, G. D. (2016). Legal and ethical issues for health
professionals (4th ed.). Burlington, MA: Jones & Bartlett Learning.Chapter 2, “Contemporary

2. Ethical Dilemmas” (pp. 66–120)Chapter 13, “Patient Abuse” (pp. 417–436)Allen, L. P.
(2013). Fighting Medicare fraud under the False Claims Act. Health Law Litigation, 10(2),
2¬–6. Retrieved from http://www.americanbar.org/publications/litigation…Note: You will
access this article from the Walden Library databases.Beimers, T., Disenhaus, J., Kanner, S.,
Smith, C., Trilling, H., Wisor, R., Andonova, E., Furlow, A., & Thiess, D. (2017). OIG finalizes
wide-ranging amendments to civil monetary penalties regulations and Anti-Kickback
Statute safe harbors. Journal of Health Care Compliance, 19(1), 9–52. Retrieved
from https://lrus.wolterskluwer.com/store/products/jour…Note: This article is 8 non-
consecutive pages in length. You will access this article from the Walden Library
databases.Holland, R. (2014). Of discounts and dangers: Swapping, discounting, and the
Anti-Kickback Statute. Journal of Health Care Compliance, 16(1), 37–40. Retrieved
from https://lrus.wolterskluwer.com/store/products/jour…Note: You will access this
article from the Walden Library databases.Mathews, C. (2015). The hospital readmission
reduction program: Fraud and abuse concerns. DePaul Journal of Health Care Law, 17(1),
31–46. Retrieved from http://via.library.depaul.edu/jhcl/Note: You will access this article
from the Walden Library databases.Pham, G. (2015). 2014 healthcare False Claims Act
developments. Health Law Litigation, 12(2), 5–9. Retrieved
from http://www.americanbar.org/publications/litigation…Note: You will access this
article from the Walden Library databases.Sidhu, A. S. (2015). The growing threat of qui tam
litigation against healthcare providers. Health Law Litigation, 12(1), 12–19. Retrieved
from http://www.americanbar.org/publications/litigation…Note: You will access this
article from the Walden Library databases. Westling, C. R., Walsh, T., & Nelson, W. A. (2017).
Perceived ethics dilemmas among Pioneer accountable care organizations. Journal of
Healthcare Management 62(1), 18–27. Retrieved
from https://www.ache.org/pubs/jhm/jhm_index.cfmNote: You will access this article from
the Walden Library databases.apa_presentation_template.pptusw1_ddba_presentationf