Health care fraud and abuse within the Veterans Administration system Essays

Health care fraud and abuse within the Veterans Administration system Essays Health care fraud and abuse within the Veterans Administration system Paper Health care fraud and abuse within the Veterans Administration system Paper The VA was established in the year 1989. The main aim of its establishment was to provide federal benefits to the US military veterans and their respective families. The agency is perceived to be the second largest of the fifteen cabinet departments. It provides financial assistance, health care and burial benefit programs. It covers around sixty million people who are namely;  Ã‚   veterans, their respective family members and the veterans survivors. VA’s annual budget is higher than 90 billion dollars although it is seeking around $ 125 billion for next year (2011). Sixty billion dollars from its budget is stipulated for health benefits and the remaining is directed towards pensions and disabilities. Other benefits of VA include home loans, educational assistance, vocational rehabilitation for the disabled veterans and life insurance. The predecessor of VA was the veteran’s administration which had been established in 1930. VA is divided into, veteran’s health administration, national cemetery system and veteran’s benefits administration. It facilitates the management of the veterans hospitals or clinics and also disbursement and eligibility of the disability pensions (Answers.com. 2010). The VA has is plagued with many fraud cases which result from deception, poor system guidelines and many more other causes. This research proposal is going to discuss the top reasons as to why the VA is plagued with these fraud cases. Public recognition Lack of public recognition is perceived to be one of the top reasons as to why the VA is plagued with fraud. This is because no monitoring is done on the kind work of being done by men and women at the VA’s office. Vital work is basically done without much public recognition. This brings about schemes which are aimed at creating fraudulent claims for 100% disability that resulted in retroactive lump-sum payments to the deceased veterans. For example in the year 2001 a former supervisor at VA’s Atlanta regional office was sentenced for a 13- year imprisonment and also ordered to pay more than 11 million dollars as restitution for her taking part in a scheme to pay benefits in the name of deceased veterans. This calls for the undertaking in a number of corrective measures which must include technology-based and procedural controls than can quickly prevent and quickly identify similar frauds and stronger responsibility for the VA managers. Public recognition will require all the work of the veterans to be publicized and exposed in the notice boards and internal WebPages. Dysfunction of the system The second top reason as to why there is increased fraud in Veteran Affairs the dysfunction of the system which openly tends to invite fraud. Congress has also facilitated to the systems dysfunction because it has pressurized the VA into making it easier for the veterans especially when it comes to the settling of the disability claims. The VA has also currently proposed changes which will simplify the acts of deception from the veterans. Fraud emanating from deception is depicted by the higher number of veterans from Afghanistan and Iraq coupled with Post Traumatic Stress Disorder thus making for it easier for the veterans to fake the disease. Medicalnewstoday.com,(2010) describes this deception emanating from the disorder as â€Å"profitably working the levers of sympathy for the wounded and obligation to the troops, and exploiting the sheer difficulty of nailing a surefire diagnosis of a condition that is notoriously hard to define. Each of these cases represents potentially millions of dollars in tax-free benefits over the veterans lifetime benefits that may continue while the veteran works and even into retirement. This deception is facilitated by the lack of availability of the clinicians who perform these disability evaluations. This is because the clinicians assume that it is not their responsibility to assess the patient’s stories. The new rule (making it easy for the veterans to settle their disability claims) should be thoroughly researched on traumatic and PTSD. With reports indicating that the number of Vietnam War veterans who committed suicide to be more than those who died in the battle field, much of the funds should be directed towards the treatment of the veterans. Most of the military women and men in uniform are usually stigmatized when they try to seek help for the demons in their brains or minds that forces them to contemplate suicide as the way out. It will therefore be important for the health specialist to evaluate every veteran once he or she comes from the damage (Medicalnewstoday.com, 2010). Trained staff The other top reason for fraud in VA is lack of a well trained staff. A staff which has no basic concepts of what they are doing may result into poor outcome or negative output when it comes to production. Fraud comes in on the side of auditors who have no explicit knowledge of auditing. Fraud is facilitated by construction works due to the excessive prices paid in major construction. This overpayment for constructions work should be returned to the reserve fund. Audit fraud is also facilitated by some contract award actions, adminstration, contract awards and administration must be enhanced to en sure that no excess prices are paid for construction work. To improve construction contracting the VHA should ensure that contracts always result better or reasonable prices for the work which is already completed. Contracts which are in the interests of the state government are efficiently controlled to prevent waste, fraud, mismanagement and abuse. Contracting fraud was facilitated by the fact that the contractors aren’t enlightened enough to use the available resources to ensure that price determinations are adequately supported and reasonable and fair prices are achieved. Fraud is facilitated by the fact that the staff lacks the appropriate knowledge in the department’s information system. When the staff have the problem of obtaining accurate data from the information system the department basically overestimates the sum total of the reimbursements that it assumes that it will recover. For example in the year 2001 the department ended up retaining a consultant to help in billing of outstanding charges estimating that he could recover around d six million dollars, however the consultant ended up recovering a maximum of 450,000 million dollars. The VA aggravated its problems by collecting the reimbursements because it really missed training opportunities since the department and the homes have used money inefficiently in the past. Lack of training has resulted into an absence of the billing experts and also knowledge at the department insufficient training accompanied by poor management and lack of executive management sponsorship has immensely contributed to deficiencies and also errors in the department’s information system thus giving birth to a system that doesn’t work efficiently as it should. The department has tried to correct the cash flow problems but unsuccessfully. It always request loans from the general fund to enable it cover some of the timing differences cause by delays the department’s reception of federal funds or reimbursements. . Health care providers can minimize the fraud audits by training their staff well this is because it is always very easy for the poorly or untrained staff to make billing mistakes. Detailed records should also be very well kept by providers incase of any questions arising from the auditing process. Signature stamps should also be given very special considerations before they are given or used by others. Providers should safely keep the billing profiles cooperate with auditors and also take care with the collection efforts. Economic recession is also perceived to be another major reason as to why there is fraud in the veterans affairs. This is because it has caused many insurance frauds which are also evident t in veterans’ affairs. Recession is making everything so expensive that many people cannot afford. Due to this the veterans have found their salaries too little to accommodate their leisure and family needs and that is why some have been caught committing frauds through the insurance. To solve this VA should work hand in hand with the insurance fraud unit which provides focused and specialized efforts towards combating of specific crimes. Disaffection The other reason for fraud in the veteran affairs if veterans disaffection. This is because many veterans just like all the other employees see themselves threatened therefore turning into latent malefactors. This is because fraud has become an equal employer for all. Most of the veterans engage in this behavior because the can rationalize their acts to self or themselves. To discard this veteran’s disaffection which is causing fraud the VA must have special people who can maintain the organizations tradition of excellence. For this special people to be available the VA has to compete with other employer in order to attract them. VA is aware of the fact that its kind of employees become valuable over time and to keep the around then they should be offered a truly benefits package and superior compensation. The VA has been working hard to control employee disaffection for it offers a competitive salary and superior array of benefits for the veterans and their families (4.va.gov, 2009). Indifference to internal control The other reason of fraud in veteran affairs is indifference to internal control. This is because the department has poorly manage its cash and that of its three homes for it has failed to pursue some reimbursements to which it is entitled. Most of its funding for its department homes comes from the States General Fund and additional funds comes from the US department of veterans affairs from the fees paid by the residents belonging to the homes and reimbursement which is paid by Medicare. The department estimates that it loses more that 15 million dollars in state and federal funds due to some of the homes had become ineligible for reimbursements. The VA doesn’t take advantage of all the cash sources available. It also has inadequate implementation and use of its billing management information system thus causing additional loss of money. This is because billing errors and also inadequate documentation of costs the department some of the additional reimbursements for those services that the home supplies to its veterans. The VA department has also compounded it difficulties in cash flow by failing to promptly submit its claims for various reimbursements. Internal control basically controls to the fraud because it doesn’t address the lack of resources that effectively manage the fiscal operation of the veteran’s home. This makes the veterans department to poorly prepare inaccurate management reports. The other weakness of the department is that it doesn’t utilize many of the tools and also reports available in its information system. For example in the year 20012 it is estimated that homes didn’t use around 35 of   the system   modules purchased by the department including a   cost accounting module that would   have given the department   a valuable tracking and budgeting tool. Fraud is also facilitated by the fact that the veteran’s affairs department doesn’t extremely conduct limited reviews on its internal controls. For instance it is true that the VA doesn’t frequently keep current its policies and procedures manuals. It also doesn’t frequently produce some precise accurate operational reports which it could use as one of its management tools. To solve the problem of indifference in internal control the department should ensure that it has the ability to bill for the services which are provided by its three homes. This can be facilitated through the continuous seeking of recertification of its homes so that they can bill for Med-Cal and Medicare reimbursements it can also follow up some of the claims submitted to the secondary insurance providers to ascertain that it has received the reimbursements and submit or issue claims to the secondary insurers that it had not billed in the past. To ensure that there is prompt billing of charges the department should continue to mainly focus of the clearance of its backlog claims and also ensure that the staff performs all the assigned tasks so that claims can be billed promptly. To ascertain whether the consultants who assist when billing are a cost effective solution to some of its problems related to cash flow, the department should make use of the results of its current contractor as the basis to make analysis on the benefits and costs of continuing to hire the consultants. The department should also assess whether payments from medi-cal and Medicare and additional assortment of federal reimbursements will adequately or efficiently cover the cost of the consultants. The department should also take some steps in ensuring that adequate resources and tools are for controlling the fiscal operations are established. One of the steps is the development of periodic management reports which include aging reports of accounts receivable and regular reconciliation of the report with the department’s accounting records to assist the department in evaluating its cash flow and that of all its three homes. The reports however should not cover reimbursement, unbilled claims and accounts receivable. The other step is to ensure that there is a regular review of the department’s internal controls with the aim of ensuring that the department fulfils its missions and also that it keeps proper control over liabilities, expenditure, assets and reimbursement. The third step is to ensure that there are adequate training opportunities for the department employees and  Ã‚   especially the reimbursement staff to inform them of the current developments in Medicare policies and regulations (Bsa.ca.gov, 2001).

SAT Writing Prep The Best Methods and Strategies

SAT Writing Prep The Best Methods and Strategies SAT / ACT Prep Online Guides and Tips I’ve spent the past decade teaching SAT prep classes and helping hundreds of students prepare for the SAT Writing section. After taking my class, many of my former students were able to improve their SAT Writing scores by more than 200 points. My experience has taught me that having a disciplined, focused approach to your SAT prep will allow you to maximize your score. In this article, I have given you the best advice I have for preparing for SAT Writing. Using these methods will enable you to use your study time wisely and master the skills you need to be an SAT Writing superstar. I tried to arrange these tips by how important they are to acing SAT Writing. However, these are all crucial tips for SAT Writing success, and you need to follow them all if you want to fully prepare yourself. #1: Learn the Grammar Rules that the SAT Tests SAT Writing is primarily a grammar test. Knowing the grammar rules that appear on the SAT isthe most important way to prepare for SAT Writing. On the PrepScholar blog, we have written articles covering all of the grammar rules and errors that repeatedly appear on the SAT Writing section. Here they are: Subject-Verb Agreement Verb Tense and Forms Pronoun Agreement Pronoun Case Wordiness and Redundancy Idioms Run-On Sentences/Sentence Fragments Parallelism Faulty Modifiers Adjective and Adverb Errors Illogical Comparisons Relative Pronouns Word Choice/Diction You should focus your studying on the rules that are more commonly tested. We have written a post on the distribution of appearance of the grammar rules on SAT Writing (coming soon). For those of you striving for a highscore, you need to have a firm grasp on all of these grammar rules. And learn them. And understand them. #2: Do Tons of Practice Problems and Understand Your Mistakes If you want to do the best you can on SAT Writing, you have to put in the time. Doing tons and tons of practice problems will make you more confident with the material. You'll be able to recognize grammar errors more quickly and avoid falling into common SAT Writing traps. Frankly, there's a lot of SAT prep material out there that isn't good and will be of minimal help to you. The practice questions you're doing should be representative of the questions you'll find on your SAT. We've identified the quality material so you won't waste your time. To spend your time wisely, you want to do practice problems that are likely to resemble those you will encounter on the SAT. Practice with official SAT tests and make sure you're using the best books to prep for SAT Writing. Check out these articles on where to find the best SAT Writing practice tests and the best SAT prep websites you should be using. Additionally, PrepScholar has over 1500 practice problems customized to each skill. However, simply doing practice problems is not enough. Why You Need to Understand Your Mistakes While doing a bunch of practice problems will help you prepare for SAT Writing, if you keep repeating the same mistakes, your score is not going to improve. You need to understand why you're getting certain questions wrong so that you can reduce your weaknesses and raise your score. One of the most common mistakes students make in their SAT preparation is that they don't take the necessary time to comprehend their mistakes and figure out how to correct them in the future. Understanding your mistakes can be more difficult than just doing practice problems, but it's essential if you want to keep improving your SAT Writing score. How to Understand Your Mistakes Fully understanding your mistakes takes diligence and organization. Here is the process that I recommend to grasp why you made each mistake and how to improve for the future; this process is somewhat rigorous, but it's also the best way to prepare for SAT Writing: On every practice test or question set that you take, mark every question that you're even 20% unsure about. When you grade your test or quiz, review every question you marked or answered incorrectly. This way you'll be reviewing all your missed questions and the questions on which you were able to guess correctly. On your computer or in a notebook, write down the gist of the question, why you missed it, and what you'll do to avoid that mistake in the future. Create different sections for each grammar skill and put the question in the appropriate section. Try to determine why you got questions wrong on your own. However, if you're having trouble figuring out your mistakes, the College Board website has an official test with explanations. Also, Khan Academy has helpful explanation videos for some of the questions on this test. Take notes on what you specifically missed and how to improve in the future. Be as specific and as thorough as possible. For example, don't just write that you missed a subject-verb agreement question and need to do more subject-verb agreement questions. Write down how the subject-verb agreement error was presented. Was the subject placed after the verb? Did you get confused by an interrupting phrase? What resources will you use to fully learn this rule and address your weakness? Don't just take notes on your content issues. Also, write down any information about your careless mistakes and what steps you'll take to prevent making them again. Do you need to read the question more carefully? Do you need to look at the answer choices more closely? You want to really dig into why you're missing questions and focus on specific ways to improve. #3: Identify Your Weaknesses and Drill Them If you do a thorough job of categorizing your missed questions and taking notes, you should be able to identify your weaknesses. When you notice patterns to the questions you miss, find extra time to practice the areas where you're struggling. Maybe there's a specific grammar rule like illogical comparisons or parallelism that is causing you problems. Do extra content review and practice problems related to those rules. The best SAT prep books and websites will have real or realistic SAT practice problems for each specific skill that is tested on SAT Writing. (We obviously believePrepScholar qualifies, and it'sdesigned to customize your SAT prep to focus on your weaknesses.) Furthermore, you should keep going over all of the questions you missed and marked. By focusing your studying on the areas where you're having the most difficulties, you'll be using your time most efficiently. Spending the majority of your time practicing stuff you already know is not an effective use of your time. Strengthen your weaknesses! The following tip relates to the approach you should use to answer SAT Writing questions. #4: Practice Relying on Grammar Rules to Answer Questions Don't rely on what sounds right to answer SAT Writing questions, except on idiom questions. Many of the SAT Writing sentences are lengthy or use uncommon phrases. The sentences might sound odd to your ear, but that doesn't necessarily mean they're wrong. Similarly, some of the sentences contain grammar errors that are so common that these sentences are likely to sound fine to you. As such, it's vital that you practice approaching the test from a logical standpoint. Every time you answer a question, you should be able to justify your choice with a specific grammar rule. Here's an example of how you would rely on grammar rules to answer SAT Writing questions. The explanation I give to the question is similar to the thought process you should use when answering SAT Writing questions. Now, take a look at this question from a real SAT: Frequently on tour, a band called the Chieftainsrevered internationally as spirited performers oftraditional Irish music. (A) revered internationally as spirited performers (B) revered internationally and they are spirited performers (C) is revered internationally for its spirited performances (D) is revered internationally as giving spirited performances (E) are revered internationally as being spirited performers Explanation: When I first read the sentence, I immediately noticed that it does not express a complete thought. It’s a sentence fragment. The word â€Å"revered† is used as a participle and not a verb. I assumed that the correct answer would add a verb to fix the sentence fragment. Immediately, I eliminated answer choices A and B because they don’t fix the sentence fragment. Then, I had to determine whether to use the singular verb â€Å"is† or the plural verb â€Å"are†. Because the subject is â€Å"band†, which is singular, the verb should be in the singular form. I eliminated E because that would be a subject-verb agreement error. Answer choice D is incorrect because â€Å"as† is the wrong word. This is an idiom error, the only type of error in which you may have to rely on your ear for what sounds right. The correct answer is C. The sentence fragment has been corrected, the subject and verb agree, and â€Å"for† is the correct preposition to use in this sentence. When you're doing practice questions, be able to explain and justify your answer choices with your knowledge of SAT grammar. #5: Determine If You Have Time Management Issues. If So, Address Them How To Determine if You Have Time Management Issues Find an official SAT practice test, and take only the Writing sections. For each section, use a timer and treat it like a real test. If time runs out for that section and you're 100% ready to move on, then move on. If you're not ready to move on, keep on working for as long as you need. For every new answer or answer that you change, mark it with a special note as "Extra Time." When you're ready, move on to the next section, and repeat the above until you finish all Writing sections. Grade your test using the answer key and score chart, but we want two scores: 1) The Realistic score you got under normal timing conditions and 2) The Extra Time score. If the difference is more than 4 raw points, then you need to address your time management issues. How To Improve Time Management Issues Generally, time management improves as you become more familiar and confident with the content. If time management is a lingering issue for you, monitor your time spent per question. You should have a target time of 45 seconds foreach improving sentences question and 30 seconds for each identify the error question. No question should take longer than 1 minute. When you're doing your practice questions, keep track of how long you're spending on each individual question. Focus on finishing each question in the target time. For my final tip, I want to remind you about the shortest subsection on SAT Writing. #6: Don't Forget Paragraph Improvement Because there are only 6 paragraph improvement questions on each SAT, you should spend the majority of your time preparing for the sentence improvement and identify the error subsections. However, make sure you practice paragraph iprovement questions as well. Some paragraph improvement questions are similar to improving sentences questions, but others are unique to this subsection. Here are the major types of questions you will find on paragraph improvement: Macro Logic: how paragraphs relate to each other and to the main idea Transitional Logic: how sentences and ideas connect to each other Redundant Sentences: whether sentences or ideas are extraneous and can be deleted Conciseness and Style: how to choose words to express ideas succinctly and clearly When you practice paragraph improvement questions, you should use the same approach as for the other two subsections. Categorize your mistakes, take notes on why you made mistakes and how to improve, identify your weaknesses, and then spend extra time improving those weaknesses. Review this article on how to approach paragraph improvement. If you make a commitment to following the six tips I just gave you, I guarantee you'll be giving yourself the best chance to succeed on SAT Writing. Whenever your motivation starts to wane, think about your goals and why you want to do well on the SAT Writing section. What's Next? Review the article on how to get an 800 on SAT Writing. It offers more depthsome of the methods I presented in this post. Also, you'll want to check out the articles on my top study strategies and test-day tips for SAT Writing success (coming soon). Want to improve your SAT score by 160 points? Check out our best-in-class online SAT prep program. We guarantee your money back if you don't improve your SAT score by 160 points or more. Our program is entirely online, and it customizes what you study to your strengths and weaknesses. If you liked this Writing and grammar lesson, you'll love our program.Along with more detailed lessons, you'll get thousands ofpractice problems organized by individual skills so you learn most effectively. We'll also give you a step-by-step program to follow so you'll never be confused about what to study next. Check out our 5-day free trial: