Week+4++Laws+and+Regulations+Executive+Summary
pdf
keyboard_arrow_up
School
University of Phoenix *
*We aren’t endorsed by this school
Course
430
Subject
Health Science
Date
Dec 6, 2023
Type
Pages
6
Uploaded by Quiensala32
1
Title of Paper
Quiensala Hamilton
Universito of Phoenix
HCS/430
Jennifer Noren
12/25/2023 Extension
2
False Claim Laws and Regulations
This paper will go over various subject associated with the False Claims Act in the health
sector, Laws of the False Claim Act, the entity that oversees and enforces the law, The impact
that DOJ has on the health care industry, reason to comply with DOJ, requirements to stay in
compliance with DOJ and the penalties for breaking the law or ethics,
In 1863, the False Claim Act was passed to safeguard the governments programs such as
Medicaid and Medicare and other government funded programs. President Lincoln asked for its
implementation because of the unethical fraud that occurred during the American Civil War. The
False Claim Act amended during this period, significantly increasing the amount of funding the
government provided to the armed forces. The false claim act were implemented with the
intention of encouraging people who were aware of false claims to report them. Whistleblower
and qui tam, which translate to "come forward," were two of the means through which people
could come forward
.
After the false claim was implemented, it was modified in 1943, eliminating
compensation for individuals who reported false claims and imposing penalties on those who
made false claims. Once they saw that the number of false claims was beginning to rise once
more, they made the decision to reinstate payment to those who had reported false claims. People
that come forward they are protected by this law to prevent retaliation.
Law or Regulation Overseer and Enforcer
3
Entities that overseas and is responsible for enforcing False Claims are the following:
Department of Justice
Federal Bureau of Investigation
Inspector General of the Department of Health &
human Services
The Department of justice which is a federal executive department of the United States
government enforces federal laws and administration of the justice in the Untied States. In the
fiscal year of 2022, the DOJ recovered more than 2.2 billion in settlement involving fraud and
fraud claims that was against the government.
The Inspector General of the Department of Health & Human Services works with other
government entities to improves the efficiency of Medicare and Medicaid systemic changes,
enhanced compliance, effective enforcement measures, and the recovery of misused money.
The federal Bureau of Investigation also know as the White -Collar Crime is the main
organization that investigates health care fraud for both the public and private insurance
programs such as medicate and Medicare.
Impact of the False Claim Act on Healthcare
When physicians makes claims to the federal government it is important for them to
ensure that they are keeping fraud and abuse under control. Fraud claims could be costlyand can
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
- Access to all documents
- Unlimited textbook solutions
- 24/7 expert homework help
4
be damaging to the health care organization. Not all false claims are intentional, but the
organizations are accountable for them. Due to the costly lawsuits and or potential organizations
shutdowns because an organization could not recover financially laws and regulation has
impacted the healthcare organizations to implement improvement strategies that reduces false
claims submitted to the healthcare.
Compliance and Adherence to the Law or Regulation
When it comes to compliance everyone must be on the same page when
protecting the organization from committing unethical acts. There are strategies that can be
implemented to ensure the organization is in compliance with and adherence to laws and
regulations. The most important that the employees must be knowledgeable of the services that
the organizations are requesting payment for. As a manager I would Implement an effective
compliance program that includes:
1.
Proper training of employees
2.
Clear effective policies and procedures
3.
Confidential system that employees can report violations.
4.
Program that audits the program and procedures that is been
put in place.
5.
Have a plan in place to deal with accusations of fraud within
the organization.
5
Penalties for Violating the Law or Regulation
Filing false claims carries fines of up to $11,000 per claim, plus three times the program's
loss Each time a service gets billed to Medicare or Medicaid, it counts as a claim.
The consequences of filing false claims can be as high as three times the program's loss plus
$11,000 for each claim. Criminal penalties and fines can also be placed towards the physicians
which my result to prison.
Health care managers and physicians should stay updated with new laws and regulations
to ensure that they are complying. Not all fraud claims are intentional but can become an impact
on the organization. Healthcare managers responsible are conduct routine reviews and
assessments of their operations to ensure that they meet organizational and legal requirements.
Organize frequent meetings or training sessions for staff members to make sure they are
understanding expectations in compliance with the law and are using the proper procedure. It is
important for healthcare facility to implement changes when needed. Employes should be trained
and knowledgably of the change through education and training.
References
(n.d.).
The False Claims Act
.
U.S. department of justice.
https://www.justice.gov/civil/false-claims-
act
Fraud and Abuse Laws
.
(n.d.).
US department of health and human services office of inspector
general.
https://oig.hhs.gov/compliance/physician-education/fraud-abuse-laws/
6
Bothwell, M.
(2023).
what brought about the false claims act in US history
.
Brothwell law
group.
https://www.justice.gov/civil/false-claims-act
Department of Justice | Agencies | United States Department of Justice
Office of inspector general
.
(n.d.).
U.S department of health & human
services.
https://oig.hhs.gov/documents/root/1140/About-OIG-Fact-Sheet-December2023.pdf
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
- Access to all documents
- Unlimited textbook solutions
- 24/7 expert homework help