Essay on Healthcare Anti-Trust

The largest health care organization in the United States are hospitals. For-profit is an organization that operates to make a profit while a non- profit organization makes no profit. Charities and organizations reported that, 62% of the U.S. hospitals in 2003 are non-profit. Non-profit hospitals gain tax-exempt by meeting the state and federal guidelines provided, while for-profit doesn’t get these tax. The non-profit hospitals serve as charitable purpose for the community and are sometimes larger than the for-profit hospitals. Private hospitals may either be classified as non-profit or for-profit institutions.

The Patient Protection and Affordable Care Act was signed into law by President Barack Obama in March of 2010. This law provides equal access to medical care, lowered health care costs and eliminates denial of coverage of pre-existing conditions to the millions of the uninsured and insured Americans that were without and denied health care coverage. Patients who were denied coverage due to pre-existing conditions can now look forward to relief and great improvement because their illness is covered in the new policy, and care is now provided for them at next to minimal cost (Stehly,

The rapidly rising cost of health care in the United States has made access to medical care difficult for many citizens. Additionally, the number of uninsured is increasing because of job loss and reduction of employee benefits. This trend is projected to continue. The negative effect of reduced access to health care may have alarming effects on the economic well-being of the nation. The passage of the Patient Protection and Affordable Care Act (PPACA) marks the beginning of significant transformation in the United States’ health care systems. After multiple attempts to reform health care over the years, the nation’s leaders have succeeded in pushing through this landmark legislation that will ensure most Americans will have access to

Health care fraud and abuse is a significant contributor to high health care spending, resulting in the wasteful spending of health care dollars. The Federal Bureau of Investigation (FBI) and National Health Care Anti-Fraud Association (NHCAA) estimates that 3 to 10 percent of health care dollars are lost to fraud and abuse (Federal Bureau of Investigation, 2010). Fraud is the intentional deception or misrepresentation that an individual knows to be false or does not believe to be true and makes, knowing that the deception could result in some unauthorized benefit to themselves or some other person (Ryan, 2006). Bloomberg reports health care expenditures are rising faster than the rate of inflation and spending in the US has nearly doubled in the last decade and one-half of health care

Nonprofit hospitals have become a common characteristic of the hospital sector because they can be found across the country because of their presence in almost every corner, they never decline to provide treatment, and offer several community-based health programs. On the contrary, the for-profit health facilities are regarded as the corporate model of health care services as they seek to make profit first. They enjoy huge capital that enables them to develop state-of-the-art facilities and purchase the latest clinical technologies.

The purpose of the coursework is to undertake a critical analysis and an assessment of the level of competition in the insurance industry of the country of our choice. In my case, I have decided to explore the health insurance industry of the United States. One of our aims is to

In the hope of better coordinating the care of patients, improving quality and lowering costs, the ACA provides incentives for physicians and hospitals to work together in several ways, such as Accountable Care Organizations (ACO’s) or establishing bundled payments for episodes of care (Martin Gaynor, 2012 ) which has spurred consolidation (Becker, Gamble, & Rosin, 2015). Additionally, compliance with various federal programs such as Meaningful Use requires a significant investment in technology which can be fiscally challenging for smaller provider groups; driving acquisitions of these smaller entities by larger health systems. Other reasons cited by hospital administrators in the pursuit of consolidation is to ensure a steady stream of physician referrals (NPR, 2010), and to create economies of scale and increased efficiencies, the fruits of which result in reduced costs and therefore cheaper care for patients (ProMarket Writers, 2016). However, what most hospital

The typically overlooked crime of healthcare fraud has resulted in a significant monetary loss on the part of the American public paying into government run medical programs, as well as private insurance company programs. Historically, we have seen that in any instance where money is involved people have found ways to or at least have attempted to obtain it illegally. Some do it through overt acts of violence such as a robbery. Others choose more covert ways of illegally obtaining money. This is usually conducted through fraudulent activities. This is the nature of white-collar crime. There is no force or violence involved but it is still illegal. (SSA) Obviously, when such a large amount of money is involved there is

The Patient Protection and Affordable Care Act, which is also known to many as Obamacare, was signed into law on March 23, 2010 in order to reform the healthcare industry in the United States. The Patient Protection and Affordable Care Act is made up of the Affordable Health Care for America Act, the Patient Protection Act, the Health Care and Education Reconciliation Act of 2010 and the Student Aid and Fiscal Responsibility Act. It also includes amendments to many existing U.S. laws. The Affordable Care Act is very long to read, according to Obamacarefacts.com, “The Affordable care Act contains over a thousand pages of reforms to the insurance and health care industries.” However, most of the important reforms are included in the first

Healthcare services have been on the rise for over 10 years now. According to a 2012 consumer alert, the industry provided $2.26 trillion in payments for more than four billion health insurance benefit claims in the year 2011(Fraud in Health Care). The bulk of the claims and the mainstream of fraud and abuse stem from the Medicare system professionals, who are knowledgeable about the process and persuade new clients into handing over their pertinent information in hopes of deception and illegitimate claims. Multiple and double billing, fraudulent prescriptions, are some of the major flaws in this organization that has made the healthcare services industry curdle. (AGHAEGBUNA, 2011) This is a non-violet crime and is often committed by very

The external stakeholders are the community, patients, MedKey System members, CMS, HMOs (ie. Blue Cross Blue Shield and Tri-Care), and any other private insurances (Richards & Slovensky, 2004). Medicare reimbursement in Alabama was the lowest rate in the nation. This was a constant struggle for the hospital administrators to try to operate on such low reimbursements for their services, which is a threat. Eighty percent of patients were Medicare or Blue Cross in which there was difficulty-negotiating prices with Blue Cross due to monopoly. Buyers have high bargaining power as reimbursements rates are low from Medicare and Blue Cross held monopoly in the services area so negotiating prices was difficult. Suppliers have lower bargaining power due to low Medicare reimbursements and difficulty negotiating prices with Blue

A merger is a partial or total combination of two separate business firms and forming of a new one. There are predominantly two kinds of mergers: partial and complete. Partial merger usually involves the combination of joint ventures and inter-corporate stock purchases. Complete mergers are results in blending of identities and the creation of a single succeeding firm. (Hicks, 2012, p 491). Mergers in the healthcare sector, particularly horizontal hospital mergers wherein two or more hospitals merge into a single corporation, are increasing both in frequency and importance. (Gaughan, 2002). This paper is an attempt to study the impact of the merger of two competing healthcare organization and will also attempt to propose appropriate

It is important that we act in a way that is ethical, legal, and commendable. Medical professionals struggle with healthcare dilemmas that are not experienced by the general public. Medical-ethical decisions have become increasingly complicated with the advancement of medical science and technology. (Fremgen) Just like the government has laws for citizens, not having laws in healthcare would allow people to do anything they want. It is important that we study the ethics and laws of healthcare, because if we were put in a situation it is essential that we know the difference between right and wrong. In the article I found, it talks about a nurse who refuses to give CPR to an older woman who collapsed in a senior residence where she works. This article has many more ethical issues than legal issues.

The health sector is among the most important sectors in the United States economy. The government has enacted certain laws that affect the corporation’s activities and the insurance industry in general. The regulation affects competition among the health insurance companies, and the insurance industry in general.

Another group often blocked is complementary or alternative health care practitioners. These restrictions and the insurance industry unwillingness to pay for these services, gives the physicians an almost monopolist control over health care. Providers must be able to enter the market for competition to work and there must be many providers vying for the patient. To get the most out of health insurance plans Consolidation of hospitals and multispecialty group practices increases the negotiating leverage of the group but in certain areas of the US a single large medical system has become the sole provider of major health service thereby restricting competition (Shi & Singh, 2008). This consolidation while giving the hospitals and group practice leverage when negotiating prices of supplies and services tends to increase the price of health care to the patient because there is no longer any competition (Shi & Singh, 2008). For these reason “competition will remain less effective in most health care markets, because the prerequisite for fully competitive markets are not fully met” (Federal Trade, 2004, p. 20).