Health care fraud is a form of white collar crime. It involves filing illegitima

Question

Health care fraud is a form of white collar crime. It involves filing illegitimate health care claims to turn an illicit profit. The 3 major laws that protect against healthcare fraud are the Anti-kickback statute, Stark, and the False Claims Act. From the readings and independent research, find one (1) specific real life legal case example of how kickback arrangements would violate the Stark Law. In addition, discuss with your colleagues how the kickback arrangements could violate trust between provider organizations and patients. From the readings and independent research, find one (1) specific real life legal case example of a breach of the False Claims Act by a health-related organization. In addition, discuss whether health care organizations are properly equipped to ensure compliance and minimize exposure risks. If not why not?

Explanation / Answer

There are many kickback cases in many places.For example former owners of tuomey hospitals paid $49.4million for violating stark act.The stark prohibits physicians from referring their patients to other entities for designated health services(DHS) payable by medicare when the physician or an immediate family member of the physician has a direct or indirect financial relationship with the entities.The relationship between the organisation and the patients will get affected in such situations.NO patient will trust the organisations or the doctors for such violations.THe doctor patient relationship has been a keystone of care,the medium in which data are gathered and diagnosis and plans are made,complaince is accomplished by healing patients and giving them support.THe healthcare organisations should concern more for patients in case of treating and also financially.If such violations are created it will effect the mindset of the patients and forces them to search for new hospitals even if the organisation is most reputed ones.

To reduce such risks proper management team and the hospital administrator should be hired so that no one will atleast think of taking or giving bribes.A POLICY AND STANDARDS should be established,implemented and continously monitored in order to maintain the best quality care to the patients.A quality team and committees should be maintained to handle such grievances,monitored and make sure that it is not supported by that organisation.Boards or hoardings should be placed wherever needed as bribes are not accepted and it is a punishable offence.Awareness is done by conducting trainings to the staff including doctors,nurses,managers,housekeeping staff etc.THey should make sure about the consequences of supporting such acts makes life at risk zone.

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