Watch Playing by the Rules: Ethics at Work - Taking advantage

Medicare Advantage, a program in which private insurance companies provide healthcare to seniors, is an alternative to traditional Medicare. Originally conceived as a way to rein in healthcare costs, the government now pays Medicare Advantage companies nearly $200 billion a year to cover some 19 million seniors. Yet, according to the federal government, nearly 10% of the payments to those private insurance companies are improper. It's suspected many of those improper payments are the result of fraud. Several whistleblower lawsuits have alleged that some Medicare Advantage insurance companies have systematically bilked the government of billions, all part of their business model.

Read: Ethics Across Time and Culture, page 288. (Access for free at https://openstax.org/books/business-ethics/pages/9-4-ethical-issues-in-the-provision-of-health-care)Links to an external site.

Free Universal Health Care

Except for the United States, the largest advanced economies in the world all provide a heavily subsidized universal health care system, that is, a publicly funded system that provides primary health services to all, usually at a nominal fee only and with no exclusions based on income or wealth. Although these systems are not perfect, their continued existence seems assured, regardless of the cultural or political framework of the various countries. A logical question is why the United States would be an outlier on this issue, and whether that might change in the future.

Some answers, as noted in the text, lie in the United States historical reliance on a mostly private system, with approximately 83 percent of health care expenses provided by the private sector through insurers and employers (in contrast, this percentage in the United Kingdom is 17). A solution that has gained traction in recent years is conversion to a single-payer system. How might this work? One article estimates that the cost of instituting a national, single-payer health care insurance program in the United States would be $32 trillion over ten years. If this estimate is accurate, would it be an exorbitant price tag for such a program, or would it be money well spent in terms of making good health care available to all citizens?⁴⁶Links to an external site.

Reflection Questions

• Describe the parties involved and their interests.
• Describe the corporate cultures at Freedom Health and UnitedHealth which contributed to encouraging alleged fraud.
• In what two ways was Freedom Health alleged to have defrauded the government?
• How is it alleged UnitedHealths business model depended on fraudulent reporting?
• What factors, including risks and rewards, do whistleblowers face in coming forward to report fraud?
• Do you find it appropriate that health care costs be provided by a mix of private versus public sources?
• What advantages might single-payer health care offer over employer-provided coverage, care provided under the ACA, or privately purchased health insurance?

DIRECTIONS

Instructions for all case studies:

Prepare a paper that is longer than one full page.

At a minimum discuss:

1. The particulars of the case
2. The critical issues
3. The applicable points from the readings that apply
4. Personal experience with similar issues
5. Questions brought up in the exercises, and
6. How you believe most people would act in a similar circumstance.