WK6 Summative Assessment Root Cause Analysis
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Feb 20, 2024
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docx
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Summative Assessment: Root Cause Analysis
Renetta Roland
University of Pheonix
MHA/508
Stephen Gregoire
10/03/2023
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Root Cause Analysis
Understanding the meaning of Root Cause Analysis is to define the primary reason for a specific outcome or effect. Identify exactly how and why a specific event occurred, understand casual relationships, and how to prevent repeated mistakes
(Bohannan, 2023). In this paper, I will discuss the “Five Whys” method, speculations, and participation of Mr. Emeigh, how my role as a health care administrator would prevent future incidents, and what risk management strategies will be used in the case against Alpha Diagnostics.
Five Whys
In the case of Alpha Diagnostics, the 5 Whys can help lead to the root cause of why Medicare fraud took place (
MasterClass
, 2021). The article states that a Maryland health care provider was sentenced to 10 years in federal prison. The question is why was he sentenced? The
provider was sentenced to time in prison for engaging in health care fraud that resulted in the death of 2 patients. The provider created false documentation on radiology, ultrasound, and cardiology interpretation reports (Maryland Health Care Provider Sentenced to 10 Years in Federal Prison for Health Care Fraud Resulting in Patient Deaths, 2016).
The next question is why did the health care fraud in this case cause the death of patients?
The provider created false interpretation reports and falsely represented patient information so when the patient went to have surgery was treated incorrectly and because of this, the patient died (Maryland Health Care Provider Sentenced to 10 Years in Federal Prison for Health Care Fraud
Resulting in Patient Deaths, 2016).
The next question is why it was so easy for Alpha Diagnostics to create false interpretation reports and easily submit them as claims. The health care provider was able to have physician examination reports drafted and affix an actual physician’s name on the report or
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forge a physician’s signature. This is a lack of oversight and supervision on the paperwork that was submitted (Maryland Health Care Provider Sentenced to 10 Years in Federal Prison for Health Care Fraud Resulting in Patient Deaths, 2016).
The next question would be why did it take the deaths of patients to emphasize the issue of falsification of data and finally be able to catch the health care provider committing fraud? It is traced back to the issues with diagnostics interpretation and the need for better oversight and supervision to ensure that all documentation is reported correctly (Maryland Health Care Provider Sentenced to 10 Years in Federal Prison for Health Care Fraud Resulting in Patient Deaths, 2016).
The last Why in this case is why have regulations and supervision not been changed to better protect patients from this type of fraud? It was easy to falsify documentation and report claims to Medicare because of the lack of supervision and oversight (Maryland Health Care Provider Sentenced to 10 Years in Federal Prison for Health Care Fraud Resulting in Patient Deaths, 2016).
Participation Speculation
There was a 2
nd
person involved in the case and his name was Mr. Timothy Emeigh, he is
also partly responsible for helping the provider with falsified documentation and causing the death of two patients and he will serve 4 years in federal prison. Did Mr. Emeigh participate in this fraud to keep his job, or did he do it for trips and vacationing overseas? It is reported that in 2010 70% of the falsification was done by him. Most likely he participated in fraud for financial gain. Mr. Emeigh somewhat redeemed himself when he advised Mr. Chikvashvili that medical interpretation of a particular level of difficulty, so this means that he was aware of the fraud that he was about to commit but the income and lavish trips allowed him to do the job he was doing when it was not.
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Preventive Methods
As a health care administrator to keep this from happening, a two-step authentication process will be created to read and submit all forms by the requesting physician and the physician that is reading and signing off for the report. Also, I will have fraud classes once a year
and they would have to sign off after they complete the course. This way fraud incidents will stay fresh on their mind, and it will make them more conscience about what they’re about to do. Risk Management Strategies
Every organization needs to have a risk management strategy to stay successful and have minimal incidents. The strategies are identifying the risk, accessing the risk, responding to the risk, and monitoring the risk (
Vicente, 2023). In this case, Physicians Mr. Chikvashivili and Mr. Emeigh knew what they were doing was wrong, and because of this, 2 patients died. If there was a supervisor that oversees the paperwork, they would be able to identify that something was wrong with the paperwork, like the signature of the physician was off or he was not on the list of providers. The assessment team would do research on the provider list to make sure everything matched. Some specifics may need a detailed report of action and decision-making around key issues, and this may include affected stakeholders lastly monitoring the risk and executing the risk to keep incidents down.
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References
Bohannan, A.
(2023).
Root Cause Analysis (RCA)
.
Salem Press Encyclopedia.
MasterClass.
(2021, June 7).
How to Use the 5 Whys Technique for a Root Cause Analysis
.
https://www.masterclass.com/articles/how-to-use-the-5-whys-technique-for-a-root-
cause-analysis
.
Maryland Health Care Provider Sentenced to 10 Years in Federal Prison for Health Care Fraud Resulting in Patient Deaths
.
(2016, June 15).
United States Attorney's Office District of Maryland.
https://www.justice.gov/usao-md/pr/maryland-health-care-provider-sentenced-10-
years-federal-prison-health-care-fraud
Vicente, V.
(2023, April 28).
10 Types of Risk Management Strategies to Follow
.
https://www.auditboard.com/blog/10-risk-management-strategies/