Question

Why do you think that healthcare fraud and abuse is such a significant problem?

What mechanisms would you implement to ensure that staff members are encouraged to report suspected or actual compliance violations?

What impact does the student anticipate that RAC programs have on corporate compliance programs?

Answer 1

FRAUD

-It is an intentional misrepresentation of fact that can result in unauthorized benefits.

HEALTH CARE FRAUD

-It is defined as knowingly and willfully executes or attempts to execute a scheme to obtain by means of false or fraudulent pretenses, representations, or promises any of the money or property owned by any healthcare benefit programs.

Types of Health care fraud:

-In ambulance service.

-In nursing homes.

-In billing section.

-In Pharmacy.

-In hospital agents.

-In hospital equipments.

-In accidental claims.

other:

• Billing for more services than capable in a work day.
• Billing for service but another was provided.
• Billing for services not provided.
• Document alteration
• Duplicate billiing.
• Ordering services that are not medically necessary.
• Providing services that are not medically necessary.
• Unbundling services.

1.

Health care fraud and abuse are a significant problem because,it will alter all the hospital and medical guidelines.More than that it will also affect the client and their health and wealth.The above mentioned theme give a clear picture of that.

2.

-Arrange a weekly based meeting or discussion.

-Arrange a complaint box.

-Always provide an opportunity for others to share their views.

By doing this,the staff members can report the violations.

3.

RCA program:

-RCA was created in 2003 and it's main role was to track and recover past unnecessary payments claims made to health providers by the patients.

-It also ensures that the health professionals comply with the set health regulatory framework.

-The program aims at promoting dignity and integrity of health providers,when dealing with the patients.

-It covers how a particular medical case was handled and how the process of billing the patient was arrived at so that the patient is not overcharged or exploited.

Coperate compliance program:

It is a formal program specifying an organization’s policies, procedures, and actions within a process to help prevent and detect violations of laws and regulations.

Impact:

-By these programs,the Health care fraud and abuse can be prevented.This will also help the patient from overcharged or exploited in anyway.

CONCLUSION

Here we discuss about,

-Health care fraud and abuse.

-Types of Health care frauds

-Method to encourage staff members for report violations.

-RCA

-Coperate compliance program.

-Its impact