Chapter 16 Questions
1. A physician and his colleagues decide to set up a laboratory owned by a dummy corporation in their wives' names and begin to refer patients to this laboratory. What (if any) laws have they violated?
Whilst referring their very own patients to a laboratory, the physician and his colleagues violated the False Claims Act (FCA) and the Physician Self-Referral Law because they formulating a dummy corporation in a means of deceiving its patients and the government.
Confronted with rising costs, the Federal government is fomenting a quiet revolution in how doctors and hospitals are paid and regulated. At the forefront of this revolution are two trends, one punitive, and one incentive based, which will require healthcare providers to rethink the way they do business. Over the last ten years, the Federal government has dramatically increased its enforcement activities, both criminal and civil, in an effort to essentially force healthcare providers to improve the quality of care they provide. "Compliance," in contrast, refers to a separate category of risk involving reimbursement and billing issues. In its role as the largest healthcare payor in the nation, the Federal government has traditionally taken the lead in investigating and prosecuting healthcare providers who illegally obtain payment from the various federally funded healthcare programs. The purpose of the compliance function, as described by the Federal government, is to insure that facilities are in compliance with the various billing and reimbursement requirements intended to prevent such fraudulent billing (Schindler, 2009).
Schindler, D. S. (2009). Pay for Performance, Quality of Care and the Revitalization of The False Claims Act. Health Matrix: Journal Of Law-Medicine, 19(2), 387-422.
2. You are the new compliance manager for a healthcare organization. Describe the steps you will take to ensure that your compliance plan is legal and effective.
In light of the new...
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