Question

Give examples of how healthcare managers can deal with fraud and abuse

Give examples of how healthcare managers can deal with fraud and abuse

Homework Answers

Answer #1

Fraud is defined as knowingly, and willfully executes or attempts to execute a scheme…to defraud any healthcare benefit program or to obtain by means of false or fraudulent pretenses, representations, or promises any of the money or property owned by…any healthcare benefit program. Abuse is most often defined in terms of acts that are inconsistent with sound medical or business practice. Unlike fraud, abuse is an unintentional practice that directly or indirectly results in an overpayment to the healthcare provider. Abuse is similar to fraud, except that the investigator cannot establish the act was committed knowingly, willfully, and intentionally. Use of the term “intentional” is important in defining fraud and abuse and in identifying ethical or unethical action. .

Know the answer?
Your Answer:

Post as a guest

Your Name:

What's your source?

Earn Coins

Coins can be redeemed for fabulous gifts.

Not the answer you're looking for?
Ask your own homework help question
Similar Questions
Topic: Fraud and Abuse Thread: Discuss the differences between fraud and abuse. During your discussion, research...
Topic: Fraud and Abuse Thread: Discuss the differences between fraud and abuse. During your discussion, research and describe a recent (within the last 10 years) example and the outcome of each. Next, explain the desirable role of healthcare managers in fraud and abuse cases. Please include two cited sources as well!
Watch the following video about Healthcare Fraud and discuss how can you avoid healthcare fraud in...
Watch the following video about Healthcare Fraud and discuss how can you avoid healthcare fraud in a healthcare facility as a healthcare manager? https://youtu.be/cSCBrenXPao
Describe your responsibility as a healthcare manager as it applies to fraud and abuse. What if...
Describe your responsibility as a healthcare manager as it applies to fraud and abuse. What if you were a unit manager? A department manager? A member of the executive team?
What are disparities in health? Give examples. Why must healthcare managers understand these disparities? Post must...
What are disparities in health? Give examples. Why must healthcare managers understand these disparities? Post must be 150 words
Why do you think that healthcare fraud and abuse is such a significant problem? What mechanisms...
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?
What does the latest research about reducing fraud, waste and abuse in insurance claims in the...
What does the latest research about reducing fraud, waste and abuse in insurance claims in the Healthcare sector tell us?
Healthcare managers must deal with three components of healthcare delivery: access to care, quality of care...
Healthcare managers must deal with three components of healthcare delivery: access to care, quality of care and the cost of care. With the move to a value based care model from fee for service, there is a stronger connection between quality of care and payment. Organizations that accredit healthcare facilities such as The Joint Commission focus on quality standards.   These organizations may also hold what is called “deemed status”. This means that the Centers for Medicare and Medicaid (CMS) will...
1) In healthcare, what can be done to improve outcomes without raising costs? Or, are the...
1) In healthcare, what can be done to improve outcomes without raising costs? Or, are the two issue too interrelated to not impact both? 2) As a healthcare professional, how would you standardize medical necessity when it comes to billing? Is there a way to avoid fraud and abuse and assure quality care for the patients?
1. Explain how managers can effectively deal with change to minimize employee stress? cite sources 2....
1. Explain how managers can effectively deal with change to minimize employee stress? cite sources 2. Identify current trends and issues facing managers? cite sources
Discuss the concept of negligence and intentional torts and give examples of these in the healthcare...
Discuss the concept of negligence and intentional torts and give examples of these in the healthcare industry.
ADVERTISEMENT
Need Online Homework Help?

Get Answers For Free
Most questions answered within 1 hours.

Ask a Question
ADVERTISEMENT