Running Head: ROOT CAUSE ANALYSIS USING 5 WHYS METHOD 1

Root Cause Analysis Using 5 Whys Method

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Introduction

Five whys analyses help in specifying a problem and asking relevant questions that gets

through various stages of the problem and ensures that the major cause of the problem is

identified. The analysis is a simple and powerful tool in offering the best response in resolving

problems (Jesilow & Burton, 2017). The paper will cover 5 whys analyses of a case study of

healthcare fraud to investigate the issue and offer preventive measures for the future.

5 Whys Analyses

Using 5 whys analyses will help identify the root cause of Alpha Diagnostics involvement in

healthcare frauds and the core participants in the case. Below are five whys and responses to

each.

Why the HealthCare provider was sentenced to 10 years of federal imprisonment

 The HealthCare provider in question Dr. Chikvashvili having been found guilty of engaging

in unethical healthcare practices challenged patients and public trust and questioning of

healthcare integrity. The practices caused by the death of two patients whose x-rays were not

well interpreted besides creating false ultrasound, radiology and cardiology reports that also were

misinterpreted and summited for insurance claims holds him responsible and accountable to the

patients and state.

Why the frauds resulted in the death of patients

The health care frauds were associated with a false interpretation of reports and false

representations that the submitted reports were compiled by a licensed physician who gave

incorrect information about patients' health condition and progress. The two patients that died

suffered health complications that were not identified in their x-rays reports and engaged them in

incorrect treatments.
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Why did it take the death of patients to set an alert on the frauds?

The frauds were conducted unsuspected until reports of the death of the two patients. It

clearly shows how easy it was for the health provider in alteration of the data and reports

undetected, which raises the question on the HealthCare supervision and regulations. No activity

should go undetected especially when it comes to sensitive data and patients’ health reports.

Why was it easy for Alpha Diagnostics to represent false insurance claims?

From the report issued, Dr. Chikvashvili was able to coordinate the drafting and forging of

HealthCare reports and make the reports appear valid and accurate to the extent that the

Medicaid and Medicare never suspected. It clearly shows how the insurance institution lacks

proper supervision and oversight in summited paperwork before responding.

Why the practitioner involves others to commit the fraud

The practitioner was driven by the greed of money that blinded him to misuses his authority.

He had minimal knowledge and experience on the field he was practicing thus used his position

of authority to incorporate his employees in undertaking the fraud scheme.

Speculations as to Why Mr. Emeigh Participated in the Scheme

Mr. Emeigh was the vice present of Alpha Diagnostics that placed him under the orders of Dr.

Chikvashvili and close business dealings with him. Mr. Emeigh got involved in the case by

engaging in the interpretation of ultrasounds, x-rays and cardiologic reports yet he was a

radiologic technologist.

Preventive Measures

It might be challenging to stop all acts of fraud, however, being proactive and implementing

preventive strategies can help protect patients and gain back public trust in healthcare integrity in

Maryland healthcare. Maryland healthcare can initiate training and education programs for
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employees alongside implementing computer-assisted coding that will monitor and federal

enforcement on similar incidences from arising or escalating (Sullivan, 2017).

Conclusion

From the five whys analyses on the case, the root cause of the frauds is lack of oversight and

regulation. Maryland healthcare needs to take immediate action to ensure effective oversight.

The federal enforcements and advanced coding can be implemented to address the insisting case

and prevent reoccurrences of the incidence.

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References

Jesilow, P., & Burton, B. (2017). Detecting Healthcare Fraud and Abuse in the United States.

In Oxford Research Encyclopedia of Criminology and Criminal Justice.

Maryland Health Care Provider Sentenced to 10 Years in Federal Prison for Health Care Fraud

Resulting in Patient Deaths. (2016, June 15). Retrieved from https://www.justice.gov/usao-

md/pr/maryland-health-care-provider-sentenced-10-years-federal-prison-health-care-fraud

Sullivan, C. (2017). Eradicating Fraud in Healthcare: Possibly a Matter of Life or Death. Journal

of Modern Accounting and Auditing, 13(8), 345-349.