CMS in Preventing Fraud and Criminal Behavior in Medicare, Medicaid, and CHIP
Using the Unit 6 Discussion Board feedback you received from your classmates and instructor on your thesis and outline, as well as the following downloadable Essay Draft Chart, create a 4-paragraph rough draft of your Academic Essay. Your draft should not use any sources at this point and instead should answer questions like: Why do you think this change has happened? or What effects do you think this change has had? Use your own thoughts and ideas to explore these questions but also try to not rely on informal first person (I, me, my, we, us, our) or second person (you, your) and instead attempt to write objectively and formally by using third person.
Think of this draft as an opportunity to try out the hypothesis you established in your preliminary thesis, to explore and examine the point you want your paper to make about the change you have selected to write about, and to learn what you do and do not know and what you need to learn about your topic in order to more successfully write about it.
Essay Draft Chart
Your 1 and ½ page double spaced draft should do the following:
Paragraph 1
Identify the change and its relevance
Establish your thesis about the cause or effect of the change
(don’t worry, though, if you are having trouble writing an attention-grabbing introduction at this point--focus on your thesis)
Paragraph 2
Establish Topic Sentence about first cause or effect
Use paragraph development strategies like PIE to support the topic sentence and explain why you think this cause or effect is relevant
Paragraph 3
Establish Topic Sentence about second cause or effect
Use paragraph development strategies PIE to support the topic sentence and explain why you think this cause or effect is relevant
Paragraph 4
Establish Topic Sentence about third cause or effect
Use paragraph development strategies like PIE to support the topic sentence and explain why you think this cause or effect is relevant
NOTE: In order to better prepare for the research process you will begin in Unit 7, brainstorm a list of specific research information you will need to locate during your research process in Unit 7 to support the ideas you drafted in Unit 6. Complete the following downloadable Research Plan Chart and include it at the end of your Unit 6 Assignment. This Research Plan Chart will help you identify the specific research information and evidence you will need to locate to support the ideas or claims in each of the body paragraphs of your draft. For help with creating a strong research plan, be sure to review the PG Library’s video, Creating a Research Plan.
Research Plan Chart
Body paragraph 1 main idea (cause or effect of the change)
What research information/evidence will I need to locate in Unit 7 to validate this main point and supporting ideas?
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Body paragraph 2: Main idea (cause or effect of the change)
What research information/evidence will I need to locate in Unit 7 to validate this main point and supporting ideas?
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2.
3.
Body paragraph 3: Main idea (cause or effect of the change)
What research information/evidence will I need to locate in Unit 7 to validate this main point and supporting ideas?
1.
2.
3.
CMS Implements New Rule to Prevent Fraud and Criminal Behavior in Medicare, Medicaid, and CHIP
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CMS Implements New Rule to Prevent Fraud and Criminal Behavior in Medicare, Medicaid, and CHIP
The Centers for Medicare and Medicaid Services (CMS) recently issued a rule to reduce criminal behaviour in Medicaid, Medicare, and the Children's Health Insurance Program (CHIP). The rule is supposed to prevent fraud from agencies. The relevance of this change is that the agency can prevent fraud before it happens, which helps protect the health insurance programs. Unscrupulous agents will no longer be paid, saving the insurance programs money. The rule greatly benefits the country since the money is dedicated to improving healthcare provision. The CMS rules will make Medicaid, Medicare, and CHIP safer, more secure, and more efficient in providing health insurance.
With the new rules, the CMS will become more cautious with new Medicaid applicants. The reason is that the new rule comprises several revocation and denial authorities that bolster the agency’s efforts to stop abuse, waste, and fraud. Rather than paying and chasing fraudsters later, the CMS must revoke and deny applications from individuals or organizations that fail to meet the set criteria. Such an approach requires caution when reviewing and approving applications. The caution is extended to individuals and organizations affiliated with others who have been revoked or flagged as potential fraudsters. Therefore, the CMS denies applications to fraudsters and their affiliates. Such caution is necessary for various resources. The most important of these reasons is that the system becomes efficient as few or no fraudsters succeed in their application.
The CMS will become stricter and more careful when paying bills to Medicaid agencies or providers. This effect of the new rule considers that those organizations or individuals approved do not necessarily qualify for Medicaid claims. In other words, a second layer of security is implemented in that after cautious approval during the application, a cautious handling of claims follows. Even approve...