I AM ATTACHING THE BOOK WE STUDIED FOR THIS COURSE, ALL THE CASES ARE PRESENT AT THE END OF EACH CHAPTER, YOU CAN SEE IT. PLEASE PROVIDE LOGICAL AND RESONABLE ANSWERS TO THESE QUESTIONS AS YOU CAN SEE...

Page | 2
Answer – 1
False Claims Act (FCA) comes into action as and when a US employee submits a fraudulent claim for governmental approval while knowingly modifying or concealing evidence and facts related a range of services, including health care and surgery. FCA will require execution in the presented case based on the filing of a fraudulent claim related to the rendered surgical interventions. For example, the concerned surgeon will be subjected to FCA in scenarios when they undertake unnecessary surgeries in the absence of valid medical necessities with the core objective of increasing the cost of surgeries to earn a greater profit. This act will not only compromise the health and wellness of the treated patients but also reduce their trust in the medical fraternity. Furthermore, the scenarios where the concerned orthopedic surgeons document false medical conditions also become the subject of FCA execution (Bernstein). The contractual agreement of the orthopedic surgeons in the presented context and submission of fraud surgery claims will also make SMC (Struggling Medical Center) liable to penalties in accordance with the SMC stipulations. The individual surgeon in the presented scenario will be subjected to five years of imprisonment and/or a penalty of $25,000 (Showalter 557). The offenders, including SMC and the concerned surgeons, will be excluded from their engagement in various Medicaid and Medicare programs and fined in accordance with the civil money statutes. The civil penalty in such cases might exceed $50,000 for each contravention. The offenders will also need to submit a hefty amount (equivalent to three times of the remuneration value) in addition to the imposed penalties. The criminal context of the federal law will enforce a penalty of $500,000 or more on SMC and $250, 000 or more on the defaulter surgeon following an escalation of false treatment claim (Showalter 557). The treatment providers or orthopedic surgeons at SMC will become the subject of FCA proceedings after undertaking unnecessary refe
als during the postoperative period in the absence of a therapeutic requirement. For example, a physician from the multispecialty group of orthopedic physicians might refer his/her patient to another physician of the same group in a scenario when each refe
al will increase the compensation of both physicians (Showalter 553-560). The safe ha
oring of medical services by the orthopedic surgeons through the Stark self-refe
al convention in the absence of a valid requirement will also penalize them in accordance with the anti-kickback statute. Orthopedic surgeons in coordination with SMC will not be authorized to claim payments for the joint replacement surgeries or associated treatment interventions covered through the federal health program for selected patients. However, efforts to claim the payments for such interventions will also make the defaulters subjected to penalization through Antikickback statute. Therefore, SMC will require optimizing physician-hospital alignment in a manner to reduce the escalation of false treatment claims while concomitantly maintaining the profitability of the concerned stakeholders and improving the treatment outcomes (Page et al.).
Answer – 2
The attending physician in the presented case required evaluating immediate treatment coverage options in the context of providing extended trauma care to reduce the risk of Mr. Green’s extremity paralysis. The treating physician required evaluating the ACA (Affordable Care Act) provisions to make a calculated decision regarding Mr. Green’s conventional trauma care work-up and pharmacotherapy in the emergency department (Kominski et al.). Physician’s knowledge of trauma care reimbursement based on ACA-related insurance expansion could have saved the functionality of Mr. green’s extremities in the presented context (Scott et al.). Furthermore, the treating physician could have evaluated the provision of tax credits for Mr. Green in the context of levering a substantial reduction in trauma-care cost without compromising the treatment quality (Showalter 63). The treating physician and health care teams in the presented context substantially violated EMTALA (Emergency Medical Treatment and Labor Act) provisions while denying the provision of conventional screening, extremity stabilization and trauma care for Mr. Green. EMTALA obliges the emergency care physicians to mitigate the emergency crisis i
espective of the status, wealth, socioeconomic, and insurance status of the patient populations. The concerned physician failed to deal with the distressed patient and violated EMTALA provisions while discharging him with Tylenol and ice-pack despite knowing the possible clinical complications. The treating physician summarily ignored the unfunded EMTALA mandate while refusing to undertake an appropriate medical screening examination to rule out and evaluate the possible clinical outcomes in Mr. Green’s case (Zuabi et al.). Furthermore, the stabilization of Mr. Green’s traumatized legs was not effectively undertaken in accordance with the capacity of the emergency department. The timely treatment, consultation, and hospital admission of Mr. Green were also not performed in accordance with his traumatic condition in the...