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States as Policy Laboratories

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It has often been noted by scholars that the fifty states are policy laboratories that craft and implement public policies that are very specific and relevant to their state populations. In many cases, these experiments sometimes rise to the level of becoming a national policy because Congress will use them as model legislation. Describe any specific policies within your state that have been crafted in response to unique circumstances in your state. For example, Louisiana has fashioned many new policies involving emergency responsiveness since Hurricane Katrina, and California has many unique policies concerning the environment that are not found in other states. Provide a brief review of one policy in your state that you find interesting.

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A policy in my state of North Carolina that I find very interesting, is the policy that individuals that are in possession of illegal substances must pay ...

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Quality Health Plan (QHP)

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Quality Health Plan (QHP) is a health insurance company operating in the Northeastern United States. A team of investigators was tasked to analyze claims submitted by health care providers to the insurance company and report unusual patterns or incidence of fraud. The investigators found many instances in which policy holders listed their married children under their insurance policy. The policy stated that policy holders could list only unmarried children under age 18 or between ages 18 and 22 if they are in college. Additionally, investigators found that heart monitoring tests performed by a particular lab cost QHP an average of $2,000 more than those of other labs. There have been reports that employees were sharing passwords and were heard discussing confidential patient information. In other findings, $500,000 worth of claims relating to male medical procedures was submitted on behalf of females. Further, the investigators discovered many claims submitted on behalf of patients who were not members of the plan. A whistle-blower had hinted that the head of the internal control department owned part of a major lab in the area. QHP did not follow up. QHP had already settled all the invalid claims in compliance with the 90-day payment agreement.

Write a memo to the CEO of QHP, Jim Hester, explaining the actual and possible losses to the health plan. What internal control measures will you recommend to QHP?

Include the following:

Control policies
Control activities
Control procedures

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