With the financial systems of our medical institutions as nuanced as they are, taking precautions against healthcare fraud must be equally as nuanced. Fraud cases cost medical practices substantial expenses in investigations and loss of reputation and business. Accordingly, all medical practices should have established plans to avoid fraud and protect themselves and the patients they serve.
What is Healthcare Fraud?
Healthcare fraud is defined by HIPAA as deliberately and willfully implementing or attempting to affect schemes to abuse the health benefits of medical programs or acquire any of the financial assets using fraudulent claims, presentations, or promises. If someone seeks to utilize or circumnavigate established healthcare systems for their own personal gain, it is considered healthcare fraud.
Legal Provisions Against Fraud
There are three major laws that are specifically designed to limit fraud in healthcare settings. These serve as primary pillars of and corollaries to more general fraud legislation.
Federal False Claims Act
The Federal False Claims Act is the United States government’s primary piece of legislation against fraud. First implemented during the Civil War, the act imposes civil responsibility on individuals who deliberately submit or initiate the submission of fraudulent claims to the federal government. Under the False Claims Act, whistleblowers are provided with job protection under the qui tam provision if they are filing against a party that has defrauded the federal government.
Anti-Kickback Statute
The Anti-Kickback Statute is designed to inhibit those who solicit compensation or give or accept remuneration for services provided by federal health programs. In other words, the statute brings legal action against those who incentivize referrals of federal healthcare programs. Intentional or complicit remuneration prohibited includes drugs and supplies and other non-cash incentives.
Physician Self-Referral Law
Also referred to as the Stark Law, the Physician Self-Referral Law forbids provider referral to receive services payable by Medicare or Medicaid at an entity in which the provider has a financial relationship. This may include services in which a physician or immediate family member has ownership, an investment interest, or a reimbursement arrangement. Providers who violate this law may face fines in addition to exclusion from participation in federal healthcare programs. According to its strict liability statute status, proof of specific intent to violate the law is not required to bring legal action against the party in question.
Recommendations for Providers
The Office of Inspector General (OIG) offers several suggestions to providers for protecting against healthcare fraud and responding in its event. Follow these to promote compliance within your organization and trust both among staff and clientele.
A Designated Plan
A stringent plan of compliance is a strong defense against healthcare fraud. This plan should include policies which support a healthcare facility’s adherence to enforcement and which innumerate methods to combat suspected fraud, i.e. claims processing. Make sure that contingency measures and regulations are written clearly and policies are defined adequately. The plan of compliance should be distributed effectively among the staff and trained upon regularly.
Chain of Command
Have designated individuals to whom employees may go to report suspicious activity. A Chief Compliance Officer at minimum is a necessity, and other personnel responsible for monitoring organization and compliance should be available resources to ensure efficient communication and above-board procedures and transactions. These individuals should report to the governing body of the clinic or hospital.
Detailed Reporting Strategies
Procedures for medical fraud reporting should be well-maintained and documented. They should also be easily accessible to staff; consider the use of a hotline. Make anonymity protection measures a priority to foster immediacy and candidness when fraud is reported.
Defined Response Procedures
Have an established framework in the event of health fraud and abuse charges. Make all employees aware of the disciplinary steps, up to and including termination and legal action, against those who breach compliance laws and policies.
Frequent Audits
As with all good business practice, implementation of reviews and audits to monitor compliance tends to improve adherence. Track enforcement assiduously to minimize more serious auditing problems. In the event that employees must be retained or terminated due to reasons of fraud or noncompliance, ensure that investigation and remediation are systemic and thorough, taking measures to improve policy implementation if such is found to be necessary.
Guard Against Fraud
To protect your clinic or hospital against healthcare fraud, reach out to our medical billing services at Aspen Ridge Medical. We adhere to strict compliance policies to maintain ethical billing procedures to prevent fraud and abuse in the healthcare practices we serve. Give us a call today to begin.
SLOT says
ฝากถอนออโต้ ไม่มีขั้นต่ำ เว็บสล็อตตรงไม่ผ่านเอเย่นต์ สล็อตวอเลท ขั้นต่ำแค่ 1 บาทเท่านั้น
Car Removal Perth says
There’s definately a great deal to find out about this topic. I love all the points you have made.
journeyjamboree.com says
After exploring a handful of the articles on your website, I honestly appreciate your technique of writing a blog. I added it to my bookmark webpage list and will be checking back soon. Please check out my web site as well and let me know your opinion.
slotsite says
Good post. I learn something totally new and challenging on sites I stumbleupon everyday. It will always be interesting to read articles from other writers and practice a little something from other websites.
驼峰 says
I used to be able to find good advice from your blog articles.
seo company for plumbers says
Youre so cool! I dont suppose Ive read anything such as this prior to. So nice to uncover somebody by incorporating original ideas on this subject. realy appreciation for beginning this up. this website is one area that is required on the web, a person if we do originality. beneficial task for bringing something totally new towards the world wide web!
789bet says
The next time I read a blog, Hopefully it won’t disappoint me as much as this particular one. I mean, Yes, it was my choice to read, however I actually believed you’d have something helpful to talk about. All I hear is a bunch of whining about something you could possibly fix if you were not too busy searching for attention.
WW88 says
Hello! I just would like to offer you a big thumbs up for your great information you have right here on this post. I’ll be coming back to your blog for more soon.
U888 says
When I originally commented I appear to have clicked on the -Notify me when new comments are added- checkbox and from now on each time a comment is added I get four emails with the same comment. Is there an easy method you are able to remove me from that service? Cheers.
Carbo Fire says
This is exactly what I needed to read today Your words have provided me with much-needed reassurance and comfort
Neurozoom official website says
Your writing is so engaging and easy to read It makes it a pleasure to visit your blog and learn from your insights and experiences
順調ですか 敬語 says
Government bond markets have had one other difficult month.
geekbar says
I needed to thank you for this very good read!! I definitely loved every little bit of it. I’ve got you bookmarked to check out new stuff you post…
周庭 ツイッター says
Whereas some cities have made significant progress in providing age-pleasant features, there is still room for improvement in others.
北海道地理中学 says
In the event you happen to have a bike, you would need to look at the Zumo line made for all those weekend bikers on the market.
環境経済 政策学会 会員数 says
The point is, when undertaking improvement projects in order to enhance your home’s resale value, keep an eye on the market value of your area first.
ガミを食う says
If you buy bread or hamburger rolls at the grocery store, you’ve got probably taken off a clip or a twist tie to get on the baked good.
三光 ホールディングス says
This is the feeling of nationality that binds such a large inhabitants into one string of being Indian by start and spirit.
三井 松島 ホールディングス says
If you have the cash to place down 20 p.c on the acquisition of a house and have strong credit score scores, then you’ll be able to qualify for a conventional mortgage.
メタファー ゲーム says
Remember, lengthy-dated bonds offer higher coupons but can leave you liable to curiosity charge threat.
Love confession without fear says
Hi there! I just wish to give you a big thumbs up for your great info you have got right here on this post. I am coming back to your web site for more soon.
prodentimpills.com says
This blog is such a hidden gem I stumbled upon it by chance and now I’m completely hooked!
https://redboostsbuy.com says
Your content always manages to captivate and educate me. Keep up the fantastic work!
seo services for plumbers says
It is the best time to make some plans for the future and it’s time to be happy. I have learn this post and if I may just I wish to suggest you few interesting things or suggestions. Perhaps you can write subsequent articles regarding this article. I want to learn more things approximately it!
Pineal XT official says
This blog is like a virtual mentor, guiding me towards personal and professional growth Thank you for being a source of inspiration
Sensory luxury experience says
I was very happy to uncover this page. I need to to thank you for your time just for this fantastic read!! I definitely liked every part of it and I have you saved as a favorite to look at new things on your blog.
SLOT says
สล็อตเว็บแท้ในปี 2025 เว็บสล็อต นำเข้าเกม API ตรง แตกง่ายไม่ผ่านเอเย่นต์
Livpure buy says
This blog post hit all the right notes!
Titan Flow price says
It’s clear that you have a deep understanding of this topic and your insights and perspective are invaluable Thank you for sharing your knowledge with us
Titan Flow says
Your writing is so relatable and down-to-earth It’s like chatting with a good friend over a cup of coffee Keep sharing your wisdom with us
salt trick to stay hard says
Oh my goodness! Impressive article dude! Thank you so much, However I am experiencing difficulties with your RSS. I don’t know why I am unable to subscribe to it. Is there anybody else having the same RSS problems? Anyone that knows the answer will you kindly respond? Thanks!!
good88b.info says
Good information. Lucky me I came across your blog by chance (stumbleupon). I have saved as a favorite for later!
forex brokers in india says
That is a good tip especially to those fresh to the blogosphere. Brief but very precise information… Thank you for sharing this one. A must read post.
software erp says
This is the right site for anyone who wishes to find out about this topic. You know a whole lot its almost hard to argue with you (not that I actually would want to…HaHa). You definitely put a new spin on a topic that has been written about for years. Wonderful stuff, just wonderful.
plumber seo reviews says
Hello! I want to offer a enormous thumbs up with the fantastic information you could have here with this post. I will be returning to your blog post for much more soon.
Quietum Plus says
Your posts are so thought-provoking and often leave me pondering long after I have finished reading Keep challenging your readers to think outside the box
온라인슬롯 says
There’s definately a lot to learn about this subject. I love all the points you have made.
https://igenicsbuy.com says
Keep up the amazing work!
Java Burn says
Your writing is so eloquent and persuasive You have a talent for getting your message across and inspiring meaningful change
Puravive says
I appreciate how well-researched and informative each post is It’s obvious how much effort you put into your work
Glucoberry order says
Your writing is so eloquent and persuasive You have a talent for getting your message across and inspiring meaningful change
Nagano Lean Body Tonic says
Your words have the power to change lives and I am grateful for the positive impact you have had on mine Thank you
Kerraessentials says
It means so much to receive positive feedback and know that my content is appreciated. I strive to bring new ideas and insights to my readers.
Mitolyn official says
Your blog post was fantastic, thanks for the great content!
Nitric Boost Ultra usa says
This blog is like a breath of fresh air in the midst of all the negativity on the internet I’m grateful to have stumbled upon it
Sumatra Slim Belly Tonic order says
Your writing is so eloquent and engaging You have a gift for connecting with your readers and making us feel understood
成田 警報 says
Pare, Mike (Could 29, 2018).
この世界の片隅に 熊本 says
Leaders and Personalities of the Third Reich by Charles Hamilton, 2 vols., Bender Pub., 1984 (Vol.
Prodentim official says
Keep up the fantastic work!
Java Burn site says
This blog is a great resource for anyone looking to live a more mindful and intentional life Thank you for providing valuable advice and tips