FRAUD, WASTE, AND ABUSE CASE 2
Fraud, Waste, and Abuse Case
Financial Scenario
The financial obligation was handled inappropriately by both the physician and the
medical institution against the State, which therefore qualifies as a false claim. The medical
facility filed for government’s reimbursement, yet the amount was to be met by the device
organization. Being a clinical trial, the practitioner and the health facility ought to have specified
the expenses covered by the research’s facilitator, and the federal government, respectively.
However, the criterion was adversely ignored, leading to the issue of double billing.
Validity of the Process
The billing procedure was evidently fraudulent from inception. Accordingly, the medical
facility could have initiated the process by confirming its association with the research’s sponsor
and the lead investigator. In case the engagement existed, the hospital personnel had to ascertain
the services rendered by the facility. Basing on the case study, the medical staff hardly read the
order form to ascertain their responsibility in facilitating the x-ray. Again, in a standard medical
billing process, the medical officer was mandated to discern the payer of the listed medical
service (s) from the order form. In this case, despite double-checking the document, the staff
billed Medicare without reviewing its obligation. The health facility was also required to have a
procedure for identifying the alleged study participants.
Other Concerns
The issue of incompetency can be vividly observed from the case study. Assuredly, the
medical staff seems to lack the requisite knowledge in evaluating clinical trial processes. The
personnel failed to verify if the patient was indeed a study participant and instead, served the
