Healthcareparticularly government-funded healthcareis heavily regulated. Providers who agree to participate in these programs and accept payment for services must comply with numerous confusing (and expensive) regulations.
Consider the following hypothetical:
You are head of risk management for a that is employed by a hospital. You have just learned that Dr. Stevens, an orthopedic surgeon, has for the past three years to every who has referred patients to Dr. Stevens. What legal risks are raised by Dr. Stevens’ actions? Should this behavior be legal or illegal? What questions will you ask Dr. Stevens and what additional information do you need to gather?
Set out a stepwise plan to address this situation. Based on the conclusions you draw, by the hospital and medical group.
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