You are an employee of Big Hands Home Health Agency and are responsible for assigning RNs, LPNs, and CNAs, to go out to homes to care for clients. The owner of the agency, Lotta Gamble, is rarely around because she is out “scouting business.” In reality, she takes a lot of cruises, which she posts about on Instagram and Facebook and brags about all the gambling she does in international waters.

One day, you receive a call from an elderly woman’s daughter. “My mother says she hasn’t seen any one from Big Hands in a month—but she received bills for a daily RN visit.” You tell the woman that your boss is out of town, but as soon as she returns, you will let her know and get back to them. A few days later, you receive a similar call from another family. And then another and another. You are starting to see a pattern. Since the boss has taken her computer with her, you have no way to follow up. It will have to wait.

When your boss returns from her latest Caribbean cruise, all tanned and rested, you brief her on the assignments and employee issues. You then say, “And, we received calls from several families saying they were billed for services they didn’t receive. I told them I would investigate and get back to them. I’m guessing this is just a case of typing in the wrong numbers?” You hope.

Your boss says in a low voice, “Have you mentioned this to anyone else?”

You shake your head. “No, I waited to talk to you.”

“Good girl. I knew I could count on you.” She reaches into her purse. “I had a good streak on the backgammon tables. Here’s a five-hundred-dollar bonus for you. Let’s keep this little matter to ourselves, shall we?”

Those who commit crimes, including healthcare fraud and abuse, require need three things: motive/desire, opportunity/means, and victims/patients. Motives to commit fraud and abuse include, but are not limited to: jealousy, greed, anger, financial difficulties, feeling underappreciated, and, the thrill of a challenge.

What motives do you see in this case?
What opportunities/means do you see in this case?
Who are the victims of this fraud and abuse?
What laws might Lotta Gamble be violating?
Are the patients violating any laws or are they victims?
What regulatory agencies have jurisdiction over this matter?
Who should investigate this home health agency?
What are the potential penalties for Lotta?
If you take the $500 bonus and remain quiet, have you committed a crime?
Should you report this? If so, who should you call? What evidence do you have?
Should you be updating your resume and looking for a new job?
Support your responses with scholarly articles and rationales.
(Doesn’t have to be anything long)

 

Sample solution

Dante Alighieri played a critical role in the literature world through his poem Divine Comedy that was written in the 14th century. The poem contains Inferno, Purgatorio, and Paradiso. The Inferno is a description of the nine circles of torment that are found on the earth. It depicts the realms of the people that have gone against the spiritual values and who, instead, have chosen bestial appetite, violence, or fraud and malice. The nine circles of hell are limbo, lust, gluttony, greed and wrath. Others are heresy, violence, fraud, and treachery. The purpose of this paper is to examine the Dante’s Inferno in the perspective of its portrayal of God’s image and the justification of hell. 

In this epic poem, God is portrayed as a super being guilty of multiple weaknesses including being egotistic, unjust, and hypocritical. Dante, in this poem, depicts God as being more human than divine by challenging God’s omnipotence. Additionally, the manner in which Dante describes Hell is in full contradiction to the morals of God as written in the Bible. When god arranges Hell to flatter Himself, He commits egotism, a sin that is common among human beings (Cheney, 2016). The weakness is depicted in Limbo and on the Gate of Hell where, for instance, God sends those who do not worship Him to Hell. This implies that failure to worship Him is a sin.

God is also depicted as lacking justice in His actions thus removing the godly image. The injustice is portrayed by the manner in which the sodomites and opportunists are treated. The opportunists are subjected to banner chasing in their lives after death followed by being stung by insects and maggots. They are known to having done neither good nor bad during their lifetimes and, therefore, justice could have demanded that they be granted a neutral punishment having lived a neutral life. The sodomites are also punished unfairly by God when Brunetto Lattini is condemned to hell despite being a good leader (Babor, T. F., McGovern, T., & Robaina, K. (2017). While he commited sodomy, God chooses to ignore all the other good deeds that Brunetto did.

Finally, God is also portrayed as being hypocritical in His actions, a sin that further diminishes His godliness and makes Him more human. A case in point is when God condemns the sin of egotism and goes ahead to commit it repeatedly. Proverbs 29:23 states that “arrogance will bring your downfall, but if you are humble, you will be respected.” When Slattery condemns Dante’s human state as being weak, doubtful, and limited, he is proving God’s hypocrisy because He is also human (Verdicchio, 2015). The actions of God in Hell as portrayed by Dante are inconsistent with the Biblical literature. Both Dante and God are prone to making mistakes, something common among human beings thus making God more human.

To wrap it up, Dante portrays God is more human since He commits the same sins that humans commit: egotism, hypocrisy, and injustice. Hell is justified as being a destination for victims of the mistakes committed by God. The Hell is presented as being a totally different place as compared to what is written about it in the Bible. As a result, reading through the text gives an image of God who is prone to the very mistakes common to humans thus ripping Him off His lofty status of divine and, instead, making Him a mere human. Whether or not Dante did it intentionally is subject to debate but one thing is clear in the poem: the misconstrued notion of God is revealed to future generations.

 

References

Babor, T. F., McGovern, T., & Robaina, K. (2017). Dante’s inferno: Seven deadly sins in scientific publishing and how to avoid them. Addiction Science: A Guide for the Perplexed, 267.

Cheney, L. D. G. (2016). Illustrations for Dante’s Inferno: A Comparative Study of Sandro Botticelli, Giovanni Stradano, and Federico Zuccaro. Cultural and Religious Studies4(8), 487.

Verdicchio, M. (2015). Irony and Desire in Dante’s” Inferno” 27. Italica, 285-297.

Sample Answer

Sample Answer

 

Motives:
In this case, the primary motive for Lotta Gamble’s fraudulent behavior appears to be greed. She is taking advantage of her position as the owner of the home health agency to bill clients for services that were not provided, resulting in financial gain for herself. Additionally, her extravagant lifestyle, as evidenced by her frequent cruises and gambling activities, suggests a desire for personal indulgence and luxury.

Opportunities/Means:
As the owner of the agency, Lotta Gamble has the means and opportunity to commit fraud and abuse. She controls the assignment of staff members and has access to client information, allowing her to manipulate billing records and falsely charge for services that were not rendered. Her absence from the office for extended periods further facilitates her ability to carry out these fraudulent activities without detection.

Victims:
The victims of this fraud and abuse are the elderly clients and their families who are being billed for services they did not receive. These vulnerable individuals rely on the assistance of home health care professionals to maintain their well-being and quality of life. By fraudulently billing for services that were not provided, Lotta Gamble is not only exploiting their trust but also potentially jeopardizing their health and safety.

Laws Violated:
Lotta Gamble may be violating several laws related to healthcare fraud and abuse, including but not limited to:

False Claims Act: Billing for services not rendered constitutes submitting false claims for reimbursement from Medicare or other insurance programs.
Anti-Kickback Statute: If Lotta Gamble is providing kickbacks or bonuses to employees as an incentive to participate in fraudulent billing practices, she would be in violation of this law.
Health Insurance Portability and Accountability Act (HIPAA): Lotta Gamble’s actions may involve improper use or disclosure of protected health information, violating patient privacy laws.

Patients as Victims:
The patients are victims in this case, as they are being unknowingly billed for services they did not receive. They are innocent parties who rely on Big Hands Home Health Agency for their care and trust that accurate billing is being conducted. They are not violating any laws; rather, they are being exploited by Lotta Gamble’s fraudulent activities.

Regulatory Agencies with Jurisdiction:
Several regulatory agencies have jurisdiction over this matter, including:

Office of Inspector General (OIG): Responsible for investigating Medicare and Medicaid fraud and abuse cases.
Centers for Medicare & Medicaid Services (CMS): Oversees Medicare and Medicaid programs and is responsible for ensuring program integrity.
State Medicaid Fraud Control Units (MFCUs): State-level agencies that investigate and prosecute Medicaid fraud.

Investigation Responsibility:
Given the severity of the fraud and abuse occurring at Big Hands Home Health Agency, a comprehensive investigation should be carried out by the Office of Inspector General (OIG) or the State Medicaid Fraud Control Unit (MFCU). These agencies have the expertise and authority to thoroughly examine Lotta Gamble’s fraudulent activities, gather evidence, and pursue legal action if necessary.

Potential Penalties for Lotta:
If found guilty of healthcare fraud and abuse, Lotta Gamble could face severe penalties, which may include fines, imprisonment, exclusion from participating in federal healthcare programs, and the requirement to repay any ill-gotten gains. The specific penalties would depend on the laws violated, the extent of the fraudulent activities, and any aggravating factors discovered during the investigation.

Personal Criminal Liability:
If you accept the $500 bonus offered by Lotta Gamble and remain silent about the fraudulent activities, you may be considered an accomplice or participant in the fraud. While it is essential to consult legal counsel for a definitive answer, accepting the bonus could potentially implicate you in criminal activity.

Reporting and Evidence:
You should report this fraudulent activity to the appropriate authorities promptly. Contacting the Office of Inspector General (OIG) or your local State Medicaid Fraud Control Unit (MFCU) would be appropriate. Gather any evidence you have, such as phone call records from concerned family members reporting the fraudulent billing and any other documentation that supports their claims.

Considerations for Job Search:
Given the unethical behavior exhibited by Lotta Gamble and the potential legal consequences associated with her actions, it would be prudent to update your resume and actively seek alternative employment opportunities. Working for an employer who engages in fraudulent activities can not only compromise your professional reputation but also expose you to potential legal consequences if you remain associated with such behavior.

 

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