Critique legal and ethical practices to prevent fraud and ab

Critique legal and ethical practices to prevent fraud and abuse.

Have the practices been effective in reducing or preventing fraud and abuse?

How does fraud and abuse impact the costs of healthcare?

Provide all your references if you use any.

Solution

Answer:

Fraud is the intentional deception or misrepresentation that an individual knows to be false or does not believe to be true and makes, knowing that the deception could result in some unauthorized benefit to himself/herself or some other person.

To prevent frauds we have laws like

1. Fraud and Abuse Laws.

2. Anti-Kickback Statute It is a felony to knowingly and willfully offer, pay, solicit, or receive any remuneration to induce or reward referrals of items or services paid in whole or in part by a federal health care program. “Remuneration” includes transfer of anything of value, directly or indirectly, overtly or covertly, in cash or in kind.

3. Physician Self-Referral Prohibition Statute The “Stark Law” prohibits a physician from making a referral for certain designated health services to an entity in which the physician (or a member of his/her family) has an ownership/investment interest or with which he or she has a compensation arrangement, unless an exception applies.

4. Deficit Reduction Act

We have enforcement agencies like:

Enforcement Agencies

• Office of Inspector-General (OIG)

• Federal Bureau of Investigation (FBI)

• Federal Department of Justice (DOJ)

• Postal Inspectors (mail fraud)

• United States Attorneys

• Medicaid Fraud Control Unit (MFCU)

• AHCA Bureau of Medicaid Program Integrity

• Medicare Integrity Contractors (MEDICs)

• Quality Improvement Organizations (QIO)

And we have potential sanctions in place.

These practices lawas and everything are very effective in preventing frauds.

Frauds and abuse increase the cost of health care of the nation. Its just because the money that is used in preventing these faruds is somthing that belongs to healthcare and should belong to health care.