ABSTRACT
An interdisciplinary, proactive perspective allows providers to engage in productive, long-term collaborative relationships with corporations, while 1) maintaining patient care improvements; 2) maintaining legality; 3) enhancing technical and clinical innovation; and 4) providing fair compensation for work done. The case study approach is used to demonstrate an effective approach to compliant behavior.
Subject(s)
Cooperative Behavior , Delivery of Health Care/organization & administration , Organizational Case Studies/methods , Professional Corporations/standards , Continuity of Patient Care/standards , Delivery of Health Care/legislation & jurisprudence , Fraud/legislation & jurisprudence , Humans , Interdisciplinary Communication , Liability, Legal , Organizational Innovation , Patient Care/standards , Practice Guidelines as Topic , Quality Assurance, Health Care/organization & administrationABSTRACT
This commentary details the providers, penalties, and affected regions resulting from US health care fraud and abuse prosecutions from January 2007 to March 2008. Database review found that over $3 billion in fines as well as incarceration in some cases were ordered for 21 convicted providers, 68 percent of whom were physicians, and to 41 nonproviders, most of whom were vendors of durable medical goods (36%), individual citizens (18%) and health care corporations (17%). Fewer claims were found against pharmaceutical firms (7%) and medical equipment manufacturers (4%). Most verdicts were in the state of Florida. False claims accounted for most of the violations for both providers and nonproviders. These severe repercussions of malfeasance should promote careful consideration and construction of the terms of engagement between health care providers, corporations, and payers.
Subject(s)
Fraud/economics , Fraud/legislation & jurisprudence , Law Enforcement , Fraud/prevention & control , Humans , United StatesABSTRACT
In 2007, the United States federal government recovered $1.54 billion for fraud in the health care industry. The government's unwavering and continuing commitment to enforcement and criminal actions compel the need for a stronger provider understanding of the regulatory framework within which corporate-provider relations must be structured. This commentary aims to review briefly the need for such education in order to protect providers from legal action and offers a straightforward, proactive compliance approach to optimize patient care and technological innovation while maintaining appropriate remuneration.
