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Fraud Discussion
Cases of fraud have been present for a long time in the medical sector. To counter these cases, governments worldwide have designed specific laws to combat their increase. Such acts include the False Claim Act (FCA) and the Health Care Fraud and Abuse Control (HCFAC) program. The FCA aims at protecting the government from overcharge or, in other cases, being sold substandard goods or services (“A Roadmap for New Physician”). Thus, it is illegal to file payment for Medicare that is fraudulent. If a false claim is filed, a fine of three times the program plus 11,000 dollars is charged (“A Roadmap for New Physician”).
The HCFAC program is designed to coordinate all government enforcement activities to combat healthcare deception and exploitation (“Health Care Fraud and Abuse”). Under the law, the Department of Health and Human Services and the Department of Justice should file an annual report to show the amount deposited to Medicare Trust and whoever was involved. These acts have been a success in the US health sector, with them controlling cases of fraud. By observing proper coding and billing, healthcare officers can ensure that the right services are rendered following the correct procedures. Besides, healthcare facilities should develop a written code to promote the hospital’s commitment to compliance. The appointment of compliance officers will also ensure compliance at a hospital level. Through regular awareness programs, healthcare units can keep their staff informed.
To comply, healthcare managers should establish a system that responds to fraud allegations, which would address these issues inside the healthcare unit. In this case, where the staff is found guilty of violating the compliance laws, they face appropriate disciplinary action. The manager should also law a system whereby the team who are guilty of violation is investigated, and retention decisions are made. The healthcare manager should also organize educational programs to ensure staff is updated on the compliance laws.
Works Cited.
“Health Care Fraud and Abuse Control Program Report.” US Department of Health and Human Services: Office of Inspector General. n.d. https://oig.hhs.gov/reports-and-publications/hcfac/index.asp Accessed on September 26, 2020.
“A Roadmap for New Physicians: Fraud & Abuse Laws.” US Department of Health and Human Services: Office of Inspector General. n.d. https://oig.hhs.gov/compliance/physician-education/01laws.asp Accessed on September 26, 2020.