Phoenix Root Cause Analysis Essay Case Study

Phoenix Root Cause Analysis Essay Case Study

Instructions:

Phoenix Root Cause Analysis Essay Case Study

Throughout this course, you have examined occurrences of the types of health care noncompliance, fraud, and abuse that commonly take place in the context of the regulatory environment in which organizations must operate. To ensure the best chance of avoiding intentional and unintentional noncompliance, health care administrators should devise and adopt a risk management plan that identifies, assesses, and analyzes the risks and tolerances inherent in the organizations processes and operations.

One of the crucial aspects of a risk management plan involves strategies for actions that should be taken in the event of a violation or breach of any nature. These mitigating actions should be followed up with remediation aimed at finding the causes leading up to the incident. This is where root cause analysis comes into the picture.

Root cause analysis is a structured, retrospective analysis of events leading up to the noncompliant event. By developing an organization-wide policy for conducting root cause analyses that is adaptable to specific operations, a cause might be determined, and preventive actions and solutions developed.

In this assessment, you examine a case of fraud and try to determine why and how it happened.

Read Maryland Health Care Provider Sentenced to 10 years in Federal Prison for Health Care Fraud Resulting in Patient Deaths from the United States Attorney’s Office.

Use the Five Whys to conduct a root cause analysis to determine why the Medicare fraud occurred and Timothy Emeigh’s participation in the case.

Write a 700- to 1,050-word analysis that identifies and evaluates the root cause for Medicare fraud in this case.

Include the following:

Articulate the “Five Whys” for this case and provide an explanation for each.

Speculate how and why Mr. Emeigh participated in the scheme.

Explain what you, as an administrator, might have done to prevent this from happening.

Recommend risk management strategies the organization can utilize to prevent this and similar types of events from occurring in the future.

Phoenix Root Cause Analysis Essay Case Study

RUBRIC
Excellent Quality 95-100%	Introduction 45-41 points The background and significance of the problem and a clear statement of the research purpose is provided. The search history is mentioned.		Literature Support 91-84  points The background and significance of the problem and a clear statement of the research purpose is provided. The search history is mentioned.			Methodology 58-53 points Content is well-organized with headings for each slide and bulleted lists to group related material as needed. Use of font, color, graphics, effects, etc. to enhance readability and presentation content is excellent. Length requirements of 10 slides/pages or less is met.
Average Score 50-85%	40-38 points More depth/detail for the background and significance is needed, or the research detail is not clear. No search history information is provided.		83-76  points Review of relevant theoretical literature is evident, but there is little integration of studies into concepts related to problem. Review is partially focused and organized. Supporting and opposing research are included. Summary of information presented is included. Conclusion may not contain a biblical integration.			52-49  points Content is somewhat organized, but no structure is apparent. The use of font, color, graphics, effects, etc. is occasionally detracting to the presentation content. Length requirements may not be met.
Poor Quality 0-45%	37-1 points The background and/or significance are missing. No search history information is provided.		75-1 points Review of relevant theoretical literature is evident, but there is no integration of studies into concepts related to problem. Review is partially focused and organized. Supporting and opposing research are not included in the summary of information presented. Conclusion does not contain a biblical integration.			48-1 points There is no clear or logical organizational structure. No logical sequence is apparent. The use of font, color, graphics, effects etc. is often detracting to the presentation content. Length requirements may not be met
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