The Unethical Issues Occur In The Columbia Hca Case Accounting Essay


The intent of this instance survey is to place the unethical issues occur in the Columbia/ HCA instance, and analysis the ground or cause factor and the better solution for this unethical issues occur.

This instance is about a health care Company name Columbia / HCA Healthcare Corporation. Harmonizing to O. C. Ferrell, John Fraedrich, Linda FerrellIt ( 2009 ) , Columbia / HCA Corporation is a company merged by Hospital Corporation of America ( HCA ) set up in 1968 with Columbia Hospital Corporation in 1994 as the faster growth of HCA. In 1997, Columbia/ HCA Healthcare Corporation had become one of the largest health- attention companies in United States. Besides that, Columbia/ HCA Healthcare Corporation besides have provided their service in United Kingdom and Switzerland. ( O. C. Ferrell et al. , 2009 )

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To accomplish their ain Vision, Mission and ends, they focus on cost effectivity and fiscal public presentation merely to go the largest concatenation of the health care centre ( O. C. Ferrell et al. , 2009 ) . As that net income oriented scheme, the company has faced many unethical issues. A For illustration of O. C. Ferrell et Al ( 2009 ) , corporation manipulated the measure charge on the authorities plan and concentrate on cost effectual by cut down the continuance preparation on their employee which consequence low quality provided.

Therefore in 1997, Columbia/HCA Healthcare Corporation faced some of the case file by authorities on their unethical issues. Therefore to reconstructing their repute and image, CEO and president of Columbia / HCA had alteration to Dr. Thomas Frist. A New CEO and president had change Columbia / HCA to a new corporate civilization. ( O. C. Ferrell et al. , 2009 ) That was switching their focal point from accent on company net income toward accent and pattern codification of ethic among their employee.

Harmonizing to O. C. Ferrell et al. , 2009, the first stairss Columbia /HCA take move toward new corporate civilization by reshape Columbia / HCA vision and mission. Their new mission of Columbia / HCA more focal point on moralss and quality issues on their services provided.

Besides altering their mission, they besides hired a senior executive, Alan Yuspeh to oversee infirmary moralss and quality issue. A After Yuspeh had given this responsible, he reorganizes its monitoring techniques, better workers ‘ moralss and conformity. Furthermore, he besides has developed a new codification of behavior and an internal mechanism for the worker to describe any non-compliance. It besides has provided preparation for the worker about the moralss issue and new codification of behavior. ( O. C. Ferrell et al. , 2009 )

Problem and publish designation

Columbia/ HCA Healthcare Corporation are a health care centre that provides healthcare service by focal point on the cost effectual and net income seeking instead than their patient demands. Therefore the corporation has incurred some of the unethical issues that affect their repute. Therefore in all the issues we identified, we found that it can group into two major job issue that are document fraud and Low quality of service provided.

The first major issue is the papers fraud. Harmonizing to O. C. Ferrell et al. , ( 2009 ) , the job was incurred in late July 1997, where the corporation was detected incurred health-care fraud in one of the Columbia/HCA Corporation, which is Fawcett Memorial Hospital that located at Port Charlotte, Florida. Government indicted that the three mid flat executive of the corporation were make fulling false cost study, in which they were soaking the Medicare and other federal wellness plan for authorities. Losingss of $ 4.4 mil in the authorities plans as from the false cost study. A whistle blower claimed that the Columbia/HCA ‘s former CEO, Richard Scott and former president, David Vandewater were already known the authorities fraudulent because they briefed routinely on this issue. ( O. C. Ferrell et al. , 2009 )

Next, the job in this major issue was overuse of home-health services was found in this instance. Columbia/HCA Corporation overstated the home-health attention laboratory-test disbursal and deliberately categorized the unrelated outgos to the client history for reimbursement. For case, For fright that hearer will catch the hyperbolic sum ; the infirmary had ‘reserved ‘ an sum of money to pay back to authorities. ( O. C. Ferrell et al. , 2009 )

Last, the job of concealed the internal papers from federal regulator was found in this instance on the papers fraud. O. C. Ferrell et al. , ( 2009 ) stated that a whistle blower claimed that the infirmary tried to conceal the internal papers that would unwrap information sing the fraud to federal regulator. Furthermore, the top executive of Columbia/HCA instructed the employee to ‘soften ‘ the linguistic communication that used in the internal fiscal audit. A ( O. C. Ferrell et al. , 2009 )

The other major issue is low quality provided by Columbia/ HCA Healthcare Corporation. This issue occurs because the corporation concentrating on net income alternatively of patient oriented was found in the instance excessively. The infirmary ‘s end which focuses to gain was different with the stated vision that was patient oriented. For case, the infirmary had shorter the preparation period to two hebdomads alternatively of six month. Then, they offered illegal inducement to physician to in exchange for patient referrals excessively. ( O. C. Ferrell et al. , 2009 )

Furthermore, the ‘patient dumpling ‘ was happened in the Columbia/HCA Corporation. Harmonizing O. C. Ferrell et al. , ( 2009 ) , they discharged or transferred the exigency room patient to other infirmary even though they know that the conditions of the patients were still unstable. The Department of Health and Human Services Inspector General ‘s Office was enforcing the mulcts on the instances of patient dumpling. ( O. C. Ferrell et al. , 2009 )

Therefore from the two major issues reference above ( document fraud and low quality service provided ) , we can presume that the corporation is an health care centre that focus on net income seeking and non practising any ethical criterion in employee working civilization and theirs ‘ duties. Does this focal point net income scheme a good scheme usage by the corporation?

Analysis and rating of fact

Before we province the analysis the major issues of the instance, we need to cognize who the stakeholders of these issues are. Stakeholders are the individual that can impact or being affected by the organisation ‘s actions. Based on this instance, stakeholders ‘ of HCA Healthcare Corporation are their clients ( authorities and patients ) and their employee.

For the client, their claim toward Columbia/ HCA Healthcare Corporation is to acquire a quality service and sensible monetary value based on the services they received. In this instance, authorities wants a just fees claim from Columbia/ HCA Healthcare Corporation. However, HCA health care deceive the authorities 1000000s of dollars by blow uping the fess through wellness insurance plans. (, 1998 ) Government challenges HCA health care with a limited budget of insurance fees. It is hard for HCA health care to carry through the authorities claim within a limited budget given by the authorities. (, 1998 ) A Therefore Columbia/ HCA Healthcare Corporation can non carry through client claim.

For patient in Columbia/ HCA Healthcare Corporation claim was want an first-class quality service received from Columbia/ HCA Healthcare Corporation. Excellent quality service means safety secure from the infirmary through the cleanliness and sterilised equipments used by the infirmary every bit good as a professional attention from their employees. Unfortunately, HCA health care focal point on net incomes instead than the patient ‘s benefits. For illustration moved the patient to other infirmaries with unstable conditions Therefore Columbia/ HCA Healthcare Corporation can non carry through the patient claim besides.

For the employee of the Columbia/ HCA Healthcare Corporation their claim are to acquire adequate preparation to guidance them in carry out their duties. However Columbia/ HCA Healthcare Corporation to be more cost effectual they had cut short their preparation continuance. This might ensue the employees acquiring non plenty preparation to manage the serious job and complicated new equipment. Therefore Columbia/ HCA besides can non carry through the employees claim.

From the above unfulfilled claim by Columbia/ HCA Healthcare Corporation to its stakeholder, it can convey challenges, menaces or chance to corporation. For the patient stakeholder would give their sentiment sing the health care services given the infirmary. It would be an chance for the infirmary to heighten its public image and repute if the sentiment is good ; or a menace to deteriorate its public image and repute if the sentiment is bad. Therefore it was a challenge for the corporation to supply a good quality service to their patient. For the employee stakeholder, they are the individual who gives the service to the patient of the corporation. Therefore if there provide good and quality service so it has an chance to increase corporation repute nevertheless if rearward so corporation repute would be affected. Therefore the type and continuance preparation that the corporation needed to form to the employee is a large challenge to corporation.

A A A A A A A After identified the stakeholder and challenges, menace and chance in this instance, start to analysis our chief issues. Our chief issue in this instance is document fraud and low quality service provided due to the accent on net income scheme. By utilizing the net income scheme in their corporate scheme, do they carry through their corporate societal duty?

A A A A A A A The corporation has the duty to economic ; adhere to the jurisprudence and regulations. They have be profitable by maximize gross revenues and minimise cost as they apply net income seeking scheme in their concern scheme. However they fail to complied with jurisprudence and regulation. They required following the accounting criterion sing the record of costs study. Besides, they besides required to follow the understanding with the authorities to supply service within their budget. Unfortunately, they fail to make so. They did non follow the accounting criterion by manipulate the cost study and deceitful the disbursals. Although they have fulfilled the economic, they fail to follow with regulation and ordinance. A

A A A A A A A Besides, the corporation is expected to be ethical in their operation that is to avoid questionable patterns and take any action that is right and just. Before the frauds of the corporation were being found in which when they are utilizing the net income seeking scheme in their concern scheme, they did non pattern any ethical codification of behavior. However, after they change their focal point to patient demands, the infirmary spends approximately $ 4 million per twelvemonth to develop its ethical plans. They provided developing plans to employees and hotline services for public to notice their dissatisfaction or found to the infirmaries. They did a great occupation because they rapidly settle the ailment from client. It can be showed in the instance that they had fired a clerk who steal the infirmaries equipment and sell it on eBay after received call from public.

After they start practising the ethical codification of behavior, they try to make some philanthropic duty. They start to make some voluntary activities without require return from the society. For illustration, Columbia/ HCA infirmary provide scholarship plan for the community. In add-on, they besides provide employment chance for the bookman to work with them after they graduate.

Following, we analyze the major issues base on the ethical theories, which are consequentialism and non-consequentialism theories. In consequentialism theories, utilitarianism is the suited theories to utilize in this instance analysis. Utilitarianism is a theory which focal point on doing any determination that can convey the greatest felicity and benefits to the largest figure of people. To utilize this theory, we need to compare its benefit and cost for utilizing the net income focal point scheme and patient oriented scheme.

The advantages of HCA Healthcare Corporation pattern net income accent scheme is the corporation can derive excess net income by claiming the unrelated outgos to client for reimbursement. Besides, the corporation can more concentrate to bring forth higher net income in be aftering their concern scheme. The cost of using this scheme is when the unethical action discovered, the corporation would confront case by their patient, so their repute to the populace and corporation net income would be affected besides.

On the contrary, the advantage of patient focal point scheme is they can supply better quality wellness attention services. As they will give a proper preparation and equal preparation continuance for their employee, it can guarantee the quality service provided by them. Besides, they need non to worry their unethical actionA will discovered by other as their actions are ethical and patient oriented. Furthermore, the infirmary can keep it ‘s repute to public by following with jurisprudence and ordinance. The good repute will give a trust for public and can pull the client. Consequently, it will increase the net income of infirmary. However, the cost of this scheme might non derive back the net income so rapidly because they ever consider on the patient needs. In making so, the infirmary will pass more to supply higher quality services to patient.

Therefore, it is really clearly to see that advantage of patient oriented scheme will give the greatest figure of felicity to most of the stakeholder than net income oriented scheme. In drumhead, pattern net income oriented scheme is unethical. A A

Following, we will analyse in one of non-consequentialist theory which is Kantian moralss theory. Basically, Kantian ethics theory divide into four parts, there are rules of right, rules of responsibility, universalism and categorical jussive mood. Under rules of right, there are human right, legal right and moral right. Human right is any action that violates human being is unethical. For the instance of HCA Healthcare Corporation, the action of “ patient dumpling ” base on the net income oriented scheme may impact the status of patient become worse. Therefore, it is unethical.

For legal right, every bit long as the action did non go against the jurisprudence and ordinance of their state is deemed to be ethical. In this instance, we know that fraud charge and illegal claim for reimbursement which base on net income oriented scheme were the action that go againsting the criterion of accounting. Therefore, it is an unethical action. Then, for the moral right, it is any taken action that will non harms other people, otherwise it i considered as unethical. Shorten the continuance of preparation to employee due to the minimisation for the cost of developing might do accident on patient, as the employees were deficiency of accomplishments. Therefore, it is unethical action besides.

Then, we come to measure the instance based on the rules of responsibility. The responsibility of employee is to supply the quality service to patient, in which complied with jurisprudence and ordinance besides. Any action against those responsibilities is considered unethical. In this instance, HCA Healthcare Corporation did n’t supply a proper wellness attention service and prepared their cost study harmonizing to accounting criterion. So, it is an unethical action.

Following, analyze and measure in universalism which means we need to handle other people in the same manner that we want to be treated. If the corporation do non desire to have a hapless and unsafely service in infirmary or if the corporation do non desire received unreasonable monetary value on the service received. Then, they should non make all that. Therefore, the action of false cost study and “ patient dumpling ” is unethical.

In categorical jussive mood, it contains of rule of terminals and rule of liberty. Principle of terminals agencies that any action that is non working other is deemed to be ethical. HCA Healthcare Corporation had shortened their preparation continuance for employee due to be minimisation is deemed to be unethical. It is because the deficiency of pattern may take to uneffective services provide which would ensue risky to the patient. Then, for rule of liberty, it means that any action against the freedom to do their determination is deemed to be unethical. A For “ patient dumpling ” , the patient did non hold the pick on the determination, as they will ever listen to the order of infirmary, even the order is an unsafely motion. A A A A

Besides ethical theories, construct of fiducial responsibility besides can utilize in analysize and measure the chief issue of this instance. Fiduciary responsibility is the responsibility that gives a trust to the individual who give you the duty. For this instance the people who give Columbia/ HCA Healthcare Corporation are their stakeholders. Columbia/ HCA Healthcare Corporation impact its ‘ repute and trust to their patient due to supply unsafely wellness attention services. Besides, it affects the trust of authorities on their services besides. it is because the infirmary claims the unrelated disbursal for reimbursement that means they make a fraud charge. Therefore, Columbia/ HCA Healthcare Corporation ‘s top direction had breach their fiducial responsibility by operate their corporation by net income oriented scheme.


In our sentiment, papers fraud and hapless service of patient attention is a important issue that non simply claims the false disbursal but besides may impact the safety of patient. It will harm other people even may decease. However these two issues would go on because they make the determination base on net income oriented scheme instead than ethical and patient demand. Therefore, we strongly agree that the net income oriented scheme is an unethical concern scheme.

Although the Columbia/ HCA Healthcare Corporation involve those unethical issue, they are seeking to take some action to avoid these issues occur in the hereafter. They changed their Chief executive officer, reshape the vision and mission of their corporation, and alter their corporate civilization focal point from net income oriented toward patient oriented. Nowadays, HCA Healthcare Corporation has been recognized by the Ethisphere Institute as one of the 2011 World ‘s Most Ethical Companies. The corporation has been successfully making an ethical civilization in their corporate.

Recommendation and Decision

In this instance, Columbia/ HCA Healthcare Corporation has shift theirs ‘ focal point from net income oriented toward ethic oriented. In our sentiment, we think that it is a wise pick and action they took on that clip. Their repute was deteriorating, after the unethical action discovered in the infirmary. To reconstruct their repute, they need to retrain their employee moralss foremost. It can be done by increasing the wage of employee and supplying the better employee compensation to transfuse the trueness among the employee. A If the employees of the corporation are loyal, they will non take any action that can harm the corporation. Hence, they will make their occupation in a more ethics manner. This can do certain that the employee will ever take the right and moralss determination when they are confronting the quandary. As a consequence, the corporation can keep their high quality service towards patient, and so reconstruct the patient trust.

Beside that, we think that Columbia/ HCA Healthcare Corporation should actuate their employee. The corporation can form some motive cantonments or negotiations to actuate their employee, particularly the experient worker. The motive negotiations or cantonments can transfuse the motive on the new employee from the initial phase. For experient employee, the motive cantonment or talk can alter their perceptual experience towards the corporation as the corporation had already changed to an ethical corporation. The talker of the motive negotiations and cantonment can stress the singularity of the corporation, to allow them cognize that their occupation is meaningful. Hence, the employee will appreciate the chance to work in an alone corporation that concern on the patient needs, alternatively of net income. The instance such as patient dumpling will non go on once more in the hereafter. A In drumhead, all these motive talk and cantonments will promote the employee to supply better services to the patients.

As we know that the corporation had already changed the corporation corporate civilization towards a more ethical and patient attention corporate civilization. However, the experient employees are used to the old corporate civilization, which are unethical and net income oriented. It might be hard for them to accommodate to a new corporate civilization in the short clip. For that ground, the corporation can form a meeting to garner the full employee harmonizing to their section. The employee can voice out their job and quandary that they face during the meeting. Then, the other employee can give remark and assist them to work out the job. The employee in quandary can work out their job ; the other employee can larn from the treatment and position it as a mention and guideline when they are confronting the same quandary following clip. Ethic can non be understood entirely by theoretical, sometimes it need to hold a treatment for the employee to happen an appropriate solution. A

In decision, Columbia/ HCA Healthcare Corporation had better their public image as they changed their focal point from profit-oriented towards patient-oriented, hence we think they need to go on their betterment and sing our suggestion.


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