Maryland Health Care Provider Sentenced to 10 Years in Federal Prison for Health Care Fraud Resulting in Patient Deaths.

To determine the why, use five questions to help you conduct an analysis of root causes.

The Five Whys is a problem-solving technique used to determine the root cause of a problem by asking “why” five times. It is more important to find the root cause than just treat its symptoms.

Follow these steps to conduct a root-cause analysis using The Five Whys:

1. The problem in this instance is Medicare fraud that results in the death of patients.
2. Ask “why” the problem occurred: E.g., “Why did Medicare fraud occur?”
3. Identify the first answer: E.g., “Because someone submitted false claims for reimbursement.”
4. Ask “why” again: E.g., “Why did someone submit false claims for reimbursement?”
5. Identify the second answer: E.g., “Because they wanted to make more money.”
6. Repeat the process, asking “why” and identifying the answers until the root cause is identified.
7. Plan to deal with the root cause.

Regarding Mr. Emeigh’s participation in the scheme, it would be speculative to assume his motives without further information or evidence. Some common motives for people to participate in fraud schemes are financial gain, the pressure of meeting performance targets, a lack of morals or ethics, or fear of losing their position or job.

Healthcare providers can prevent fraud by implementing robust compliance programs. These should promote ethical behavior and encourage monitoring and auditing of financial transactions. They also need to enforce penalties when non-compliance occurs. In addition, healthcare providers need to prioritize their staff’s education and training so that they are aware of the ethical and legal responsibilities as well as the possible consequences for fraudulent activities.

Sources:

1. Institute for Healthcare Improvement (n.d.). Root Cause Analysis: Five reasons. Retrieved From http://www.ihi.org/resources/Pages/Tools/Five-Whys-A-Root-Cause-Analysis-Tool.aspx
2. Centers for Medicare & Medicaid Services. (n.d.). Preventing Healthcare Fraud. Retrieved from https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Fraud-Abuse-MLN4649244.pdf
3. American Medical Association (2019). Healthcare Fraud prevention: strategies for physicians. Retrieved from https://www.ama-assn.org/delivering-care/patient-support-advocacy/healthcare-fraud-prevention-strategies-physicians