Reviewing the initial complaint: What are the items you should look for in a compliant to determine validity?
Reviewing the initial complaint: What are the items you should look for in a compliant to determine validity? Notifying the appropriate upper management of the complaint unless they are implicated in the complaint: What are the steps to take to determine who is involved
LASA2 Paper: Corporate Compliance
Student:
Institution.
LASA2 Paper: Corporate Compliance
Fraud has always existed and is increasing fast in most developed and emerging economies, so that it must be seen as representing a major threat to many organizations in most sectors (Pickett, K. H., 2012). In Medicare, fraud and abuse is a serious problem that must be kept in check to avoid loss of taxpayers billions of dollars and putting at risk health and welfare of medical beneficiaries.
Understanding Medicare fraud and abuse, that is, its meaning, and laws relating to the vice would help a responsible person identify such abusive practices in a facility, and assist in combating them. According to King, K. (2010), Medicare fraud, waste and abuse are characterized by improper payments, over payments and underpayments not supposed to be made, or that were made in an incorrect amount. Estimates of 2009 from Medicare and Medicaid services were billions of dollars in improper payments in the medical system (King, K., 2010).
Medicare fraud refers to making falsiful statements or improper representation of material facts for personal gain that one is not entitled to (Marcinko, D., 2011). The fraud may be committed by an individual alone or it could be a wide operation involving a particular institution or a group. According to Marcinko, D., (2011) some examples of Medicare fraud include among others:
Deliberate billing of services that were not given or supplies that were not delivered. For instance, billing for an appointment in which a patient failed to turn up.
Deliberately adjusting claims forms and/or receipts to receive a higher payment amounts.
Soliciting, offering , or receiving a kickback, bribe, or rebate (e.g., paying for referral of patients in exchange for ordering diagnostic tests and other services or medical equipment).
Deliberate duplication of payments
Just like fraud, Medicare abuse too can result to unnecessary costs to the Medicare Program either directly or indirectly. It is any practice that is inconsistent with the goals of providing patients with necessary professional medical services and at fair prices. These include: overcharging for services or supplies, falsification of information in medical record documents or providing wrong applications of codes on a claim.
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