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BHS 499 (Senior Capstone Project) Module 3 SLP - Essay Example

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Health care fraud and abuse exist in variety of schemes. Medicare, Medicaid and other federally funded health benefit programs are the targets of these schemes. Double billing schemes, billing for needless or unperformed tests, and kickbacks are some of the fraudulent activity that affected patients…
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BHS 499 (Senior Capstone Project) Module 3 SLP
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1 IMPLICATIONS OF HEALTH CARE FRAUD AND ABUSE Health care fraud and abuse exist in variety of schemes. Medicare, Medicaid and other federally funded health benefit programs are the targets of these schemes. Double billing schemes, billing for needless or unperformed tests, and kickbacks are some of the fraudulent activity that affected patients. Section 1128C(a) of the Social Security Act, designed the Health Care Fraud and Program for Abuse Control Program (Department of Justice, 2000). This are far-reaching program to overcome fraud and abuse in health care settings, both in public and private health plans.
One major implication of health care fraud and abuse is the monetary loss due to e improper activities which endanger patient safety. The United States Attorneys' offices (USAOs) are held responsible for the civil and criminal prosecution of health care providers, professionals, and other specialized business agencies who engage with health care fraud and abuse. The US government has appropriated certain amount (DOJ, 2000) from the United States Treasury general fund and they in turn must appropriate the Account for transfer some to the federal Bureau of Investigation in order to carry out the purpose and processes as described in above statements.
Another implication is the intensification of health care fraud enforcement. This can never be achieved without the cooperation of other stakeholders. In fact, the FBI is one organization involved in the said cooperative effort. Federal agencies needs to collaborate with health care fraud working groups, have a liaison program among organizations and attend trainings as well as conferences. New statutory tools are believed to support ad be provided in order to combat health care fraud. Although
the investigations are very complex and require knowledge, and skills, it is given the highest priority within the FBI (DOJ, 2000).
High Cost for Investigations, Policy Making and Management
Around $451,000 was budgeted to HCFA ($395,500) as well as the ASMB or Assistant Secretary for Management and Budget at the end of 2000 for the formal risk management operations. The funding is intended for the consulting services over the six (6) month period which ended in March 1, 2001. Part of the operations include: development and execution of best practices in the assessment, risk identification, and response management (Department of Health, 2001)along with the operations of Medicare and Medicaid.
The identified problems consequently heightened the drive of managers towards intensification of health care trainings. During the fiscal year 2000, an allocation of about $1.45 million in HCFAC funds by the Administration on Aging (AoA) to train and educate paid as well as staff of volunteer aging network in order to recognize and also to report patterns of fraud, waste, potential practices and abuse in the Medicaid and Medicare programs. Training on health insurance counselors, nursing home ombudsmen, state as well as area agency on senior center directors, social workers, elder care information specialists, aging staff, and other professionals were the focus of the training. The funding further helped to support the nationwide infrastructure for educating beneficiaries and technical assistance for those who will serve as the Medicare system's "eyes and ears" (Department of Health, 2001).
The community hopes that the opportunity to promote quality of care through the actions and interventions against fraud and abuses in the health care practices be successfully met.
The Department of Health and Human Services and The Department of Justice
(2000) Health care fraud and abuse control program. Annual Report For FY
US Department of Justice (2000) Reimbursement for the costs of conducting
investigations, audits and for monitoring compliance plans. Section
1128C(b) of the Social Security Act, 42 U.S.C. 1320a-7c(b). Read More
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