Assuntos
Fidelidade a Diretrizes/legislação & jurisprudência , Jurisprudência , Gestão da Qualidade Total/legislação & jurisprudência , Revelação , Imperícia/legislação & jurisprudência , National Practitioner Data Bank , Revisão dos Cuidados de Saúde por Pares/legislação & jurisprudência , Estados Unidos , United States Dept. of Health and Human ServicesRESUMO
Qui tam lawsuits are increasingly being used in the fight against fraud in the managed care environment. Brought by private individuals, called relators, on behalf of the U.S. government, the lawsuits aim to recover funds obtained through the presentment of false claims. The relator may eventually collect between 15% and 30% of the funds recovered. This article provides an overview of qui tam litigation and its role in the government's war against fraud.
Assuntos
Fraude/legislação & jurisprudência , Formulário de Reclamação de Seguro/legislação & jurisprudência , Revelação da Verdade , Órgãos Governamentais , Programas de Assistência Gerenciada/legislação & jurisprudência , Estados UnidosRESUMO
The National Practitioner Data Bank is a database of adverse events involving physicians and other practitioners. Querying the database is mandatory for hospitals in several situations. So too, hospitals are required to report specified adverse events. Thus, hospitals need to be able to identify incidents that are reportable events, events that require them to update the databases, and any possible liability issues that may surround the hospital's reporting duties. The author argues that the regulations are unclear in addressing these issues. Likewise, he notes that practitioners should be aware of other problems with the reporting system, including the lack of sufficient Data Bank security.
Assuntos
Legislação Hospitalar , Privilégios do Corpo Clínico/legislação & jurisprudência , National Practitioner Data Bank/legislação & jurisprudência , Revisão dos Cuidados de Saúde por Pares/legislação & jurisprudência , Gestão de Riscos/legislação & jurisprudência , Competência Clínica , Segurança Computacional , Humanos , Doença Iatrogênica , Armazenamento e Recuperação da Informação/legislação & jurisprudência , Responsabilidade Legal , Imperícia , Erros Médicos , Estados UnidosRESUMO
The federal government continues to expand its initiatives to uncover healthcare fraud, waste, and abuse. It is therefore more important than ever that healthcare organizations have an effective compliance program in place. The organization should have a compliance officer with adequate authority and staff to carry out the compliance program's functions. The program should include an ethics code, an internal hotline that employees can use to report compliance concerns, and education and training for all employees. In addition, the program should be audited periodically to ensure its viability. To be successful, a compliance program also needs the support of the healthcare organization's senior management.
Assuntos
Ética Institucional , Fraude/prevenção & controle , Fidelidade a Diretrizes , Formulário de Reclamação de Seguro/normas , Comunicação , Reivindicações Trabalhistas , Administração Financeira/normas , Humanos , Capacitação em Serviço , Auditoria Administrativa , Medicare/economia , Comitê de Profissionais , Revelação da Verdade , Estados UnidosRESUMO
Individuals and facilities convicted of health care fraud are likely to be excluded from participating in any federal health program. Knowingly disregarding the truth by submitting false claims is one type of fraud that is punishable by law--from a stiff fine to a lengthy imprisonment. Understanding the types of fraud in the health care context helps prevent abuse and liability.
