Claim 1-044: A Case Study

Claimant Josue Lopez alleges after he had graduated from the Imperial Sheriff’s Academy in June 2015 he was assigned as a Correctional Officer to Medical Department where he felt comfortable knowing that fellow Correctional Officers were there if he needed help with an inmate. The claimant said when he was at the Medical Department he was free and clear of any emotional or work-related stress until he was transferred to the Inmate Day Reporting Center in March 2015.

The current production process that Thicketwood Ltd is utilizing can no longer keep with the demand of custom kitchen cabinets. Management must implement a new step to the production line to increase efficiency; however, they must also maintain quality as the customers that are purchasing these cabinets expect top quality for the amount of money they are paying.

Is it possible to expedite an anomalous claim clearance due to the pending congressional issue?

When a law enforcement officer or other public employee is accused of potentially criminal conduct, they may face three different kinds of interviews or interrogations. If an officer is interviewed as a criminal suspect, they have the absolute right to decline to answer any questions, or to insist that they have a lawyer of their choosing to attend the interview. The first is type is during a criminal investigation; the second is during a disciplinary investigation and finally during the course of civil litigation where there has been damages. During a criminal interview, there is no professional, ethical or moral duty to participate especially without the assistance of an attorney to represent the officer under investigation. It has come to a surprise that many experienced officers will waive their right to silence and give the investigators an audio recorded statement. Some of the inexperienced criminals do not make incriminating statements. The motive for cooperation is to avoid unfavorable publicity.

Claim submission processes are claims that are submitted online, and payments are processed electronically after a visit to the doctor office the physician send out a bill to the insurance claims processing center all information that is relevant the intake forms and the patient appointment sheet as well as the proper services documentation. Which is evaluated to see if it covers the services if the services are covered by the insurance company a payment is then submitted for the balance that is remained if not insured the person is reliable for the balance that is left over as well as the co-payment.

Moreover, the claimant believes that he has presented all the necessary evidence that could have supported his claim. For instance, the defendant have intentionally interfered the claimant’s contractual agreement with the hospital by using improper means and finally resulted his termination. On other hand, the defendant prevented chances that could have allowed the claimant to return his work in later days by enticing the hospital to introduce a rule that disallows to perform any service from the hospital. Due to that, the plaintiff demanded for the appeal court to grant him the summary of judgement and reverse the circuit court decision. On the other hand, the defendant beliefs that the circuit court reach a fair decision and demands the appeal court to affirm the decision that has already been

Medicare payments rely heavily on proper coding of medical procedures and services provided during the delivery of care. Those services or processes are typically bundled, and therefore allocated as a bundling payment that receives a set amount of financial compensation for the organization. The Medicare statute maintains that the Secretary of Health and Human Services determines the fee schedule for diagnostics laboratory tests and Medicare regulations state that the hospitals must bill some of the tests as a group (Ohio Hospital Association, et. al. v. Shalala, 1997). The District Court case involved the failure to bundle seven tests, which accounted for higher Medicare reimbursements.

Permits private parties to file qui tam actions claiming that defendants defrauded the government (False Claims Act Overview, 2016).

Consider Exhibit 10 on page 22 of the case; does it include the factors you consider most important in the selection process? Which factors would you be inclined to weight most heavily?

As a veteran, you have the opportunity to seek benefits for a variety of needs through the United States Department of Veterans Affairs (VA) Benefits program.

Description is vague or is not relevant to the current practice related to the problem.

On October 24, 2012 the Unites States of America filed a lawsuit against the Bank of America Corporation for selling toxic mortgages to Fanny Mae and Freddy Mac which cost the taxpayers more than $1 billion dollars. The lawsuit sought penalties under two laws; the False Claims Act, which is normally used to target fraud against the government, and the 1989 FIRREA Law. FIRREA does not usually hold up in court, but the government is once again relying on it because of the financial crisis as a possibility for targeting civil fraud concerning financial institutions. (Viswanatha, Aruna, 2013) (Stempel, Jonathan, 2012)

• Construction methods (C1, Section 1) assessing the selected substructure, superstructure and primarily elements and the process of assembly.

Create a veneer to cover the more or less unattractive exterior of a shipping container.

Good point Tiara, the medical field can be a fast paced job and for that reason electronic claims are very beneficial. Converting from paper claims to electronic claims can be costly but at the same time save the company money and time. "Claims submitted electronically reduce postage and other paper-related expenses while increasing efficiency." ("Advantages of Electronic Claims - EDI Support Services," n.d.) Also because electronic claims solely rely on computer access and internet service, there's always the fear of the system crashing. If this did happened I don't think it would be to much of a problem because there are time limits to submit the claim and most likely the system wouldn't be down past the allowed time frame.