1. DaVita Health Care partners were accused of using more medicine vitals or unnecessary spreading medicine dosages across multiple treatments. They were allegedly doing this knowing that Medicare would pay for this “unavoidable” waste. A nurse and a Dr. that worked together noticed that expensive medicine was just being thrown away. These two men were upset this was happening and when nothing was being done to change it they filed a whistleblower case.…
Mrs. Grant is a 54 year old female who presented to the ED via LEO following an 911 call to her resident after a friend was no the phone with her and heard a gunshot in the background. At the time of the assessment Mrs. Grant denies suicidal ideation, homicidal ideation, and symptoms of psychosis. Per documentation Mrs. Grant is experiencing medical issues and relational issues, and alcohol dependence are stressors contributing to her current distress. She acknowledges last night attempting to gain her husband attention by writing him a note in regards to her being "tried of his cheating and wants him to let her know if he want to be with her or not. "…
So, a breach of warranties has transpired because the sunflowers were damaged. Thus, a summary judgment was granted Coleman’s claim of products liability, negligence, failure to warn, breach of implied warranties, and statutory violation but Summary judgment is denied on the claim of breach of express warranties. COMMERCE & INDUSTRY INSURANCE COMPANY V. BAYER…
FV Family 08/12 violated the contract with a lack of supporting documentation. Joy Medical 01/08 violated the contract because it was 5 months late for July expenses and receipts. Joy Medical 06/23 violated the contract because it lacks proper approval 7 of the 9 were found to violate the contract in some way. Process/Control Recommendations for Draw Request Process: There are serious control weaknesses with all 5 steps for the Draw Request Process.…
The highlighted language is a broad and material exception to the operation of Section 2.6. SelectCare is prohibited from denying a medically necessary claim under circumstances where good cause existed for the lack of prior authorization. This exception prevents SelectCare from unreasonably shifting the costs of its member’s medically necessary services to the Hospitals when the Hospital is not at fault. As discussed more fully below, good cause existed for the lack of authorization on each of the claims at issue. Accordingly, SelectCare’s denial of these medically necessary claims was unreasonable and payment should be made to the Hospitals.…
1. Describe the primary issues presented in the case study. The case study of the doctor in the sleep study clinic represents issues with health disparities, race, poverty/socioeconomic class, ethnicity and culture. The doctor clearly puts his own needs first as well as remains at the job due to its proximity to family and friends.…
Market Segmentation The Ottawa market has potential customers in the 13-17 target market who are adolescent. This age group is beginning to experience new things and want to explore new experiences. Creating a fun and safe environment that promotes shared values and achievements in celebrating diversity specifically for the younger generation in Ottawa and surrounding areas will be successful. The whole purpose of the plan is designed around this group of people.…
history of the different claims that it had submitted, but WellCare upheld its denial for timely filing. WellCare’s denial of this claim is in error because the claim was timely filed with WellCare following the Hospital’s receipt of ELCO’s payment. The WellCare provider manual requires a provider to submit a claim to WellCare within 180 calendar days from the date of discharge or inpatient services.…
On the surface, medical coding seems simple enough. Assign a specific code to a medical diagnosis, treatment, symptom, drug reaction, or procedure. But, when you start digging into the details of how medical coding works and what it can affect, the liability potential of applying the wrong medical codes becomes apparent. Mismatched Coding Can Lead to Insurance Fraud Claims…
The staff that works at Four Star Clinic give the first impressions a patient has of our clinic. As the manager, I have set clear expectations for the employees that work at Four Star Clinic. Hicks suggests (2016) to avoid gossip and needless chatter as much as possible to ensure that my staff is listening to what I say. Active listening is just as important when communicating with the staff. It is vital that the person receiving the information understands what is being said.…
Based on the data represented in figure 11.22, the system is under control. This is because variations appear to come from sources that are common to the process. In addition, the system shows a lot of stability and no need for corrections or changes. Important to note from the figure is that the process data can be used to predict the process future performance. For Systems not under control sources of variations are obtained by analyzing the chart since it results to a degraded process performance.…
Please answer the question in 350 words or less. Why are you interested in attending the University of Virginia School of Medicine? What factors will be most important to you in choosing a medical school? University of Virginia’s reputation as a forerunner in medical education and research with values such as excellence and leadership make it an ideal match for an engaged, driven student like myself.…
In most science fiction, stories are told from the point of view of the most relatable characters. Scrappy human freedom fighters, rebels, and malcontents overthrow the unknowable invaders, aliens, or machine overlords to preserve humanity as they know it. Rarely though, a novel comes along that takes this tradition idea and reverses it, instead relating a narrative from the point of view of the alien. This presents a unique story for readers, and a special challenge for writers. How does one write from an alien point of view when one is human?…
Olympic Medical Center has formed a strategic plan to help shape their vision for serving their community. The main key goal areas are quality, patient safety and satisfaction, community relationships, and organizational performance. Regardless of the ability to pay, each person in their community is welcome to receive health care services at Olympic Medical Center. Healthcare is subject to many outside control factors such as governmental regulations and payment systems such as Medicare, Medicaid, and insurance companies.…
The Fault in Our Stars, written by John Green, demonstrates the struggles that teenagers with cancer have. Hazel Grace Lancaster, the main protagonist was diagnosed with Thyroid cancer at the age of thirteen. After that, she has been going to community college classes and watching reruns of America’s Next Top Model. Suddenly she chose to attend a support group, mostly because her mother did not want to stay home. She meets two new friends named Augustus and Isaac, who both have/had cancer.…