Effects Of Oig Exclusion On Health Care Professionals

Under the authority of Section 1865 of the Social Security Act, hospitals accredited by TJC have been automatically “deemed” to meet all the health and safety requirements established by Medicare’s Conditions of Participation (CoP) (McGeary, 1990). In simpler terms, any healthcare organization that receives accreditation by TJC is considered in compliance with Medicare’s CoP requirements. Why is deemed status so critical for healthcare organizations? Healthcare organizations are willing to pay TJC to survey their facility to ensure that Medicare and Medicaid reimbursements continue to flow into their revenue cycle. When the federal government established their partnership with TJC, it was done with good intentions, but the union has turned into a regulatory nightmare for many healthcare

The Patient Protection and Affordable Care Act (Obamacare) had mame dramatic changes in the field of the health care system, especially in Medicare, that will seriously take effect in American seniors. Indeed, much of the health law’s new spending is financed by spending reductions in the Medicare program. In addition to the provider payment reductions, Obamacare significantly reduces payments to Medicare Advantage (MA) plans by an estimated $156 billion from 2013 to 2022.( Elmendorf, letter to Speaker Boehner). About 27 percent of all Medicare beneficiaries are enrolled in MA plans, a system of regulated and private plans competing against each other as an alternative to traditional Medicare. MA plans are attractive to beneficiaries because they offer more generous and comprehensive coverage than traditional Medicare by capping out-of-pocket costs and offering drug coverage to a rasonable

Medicare and Medicaid have cause a great deal of damage to the American society. "Years of scandal have shown the waste, fraud and abuse that is rampant in Medicare and Medicaid." (Fallen Guardians of Justice: How the Supreme Court is

The purpose of this paper is to give an overview of two federally and/or state funded programs. The programs that will be discussed are Medicare and Medicaid. In this paper will be information about who receives Medicaid/Medicare, the services offered by these programs, and those long term services that are not.

Cherry, B., & Jacob, S. (2008). CHAPTER 8 Legal Issues in Nursing and Health Care. In Contemporary Nursing: Issues, Trends & Management (5th ed., p. 185, p. 222). St. Louis, Mo.: Mosby/Elsevier.

Throughout the past decade restrictions on eligibility for taxpayer-subsidized medical care has risen at both the state and national level. Some of these restrictions are based on laws and reform acts that have been

Wright, B., & Ricketts, T. (2013). When patients govern: Federal grant funding and uncompensated care at federally qualified centers. Journal of Health Care for the Poor and Underserved, 24(2), 954-67. Retrieved from

Throughout the early 1980’s and 1990’s the Federal Medicaid program was challenged by rapidly rising Medicaid program costs and an increasing number of uninsured population. One of the primary reasons for the overall increase in healthcare costs is the

The pharmacist submitted claims for reimbursement on brand name medications rather than on the less expensive generic drugs that were actually dispensed. This is a result of health care fraud on Medicare part D, which is in violation of the False Claims Acts (FCA) and anti-kickback statues. "The FCA protects the government from being overcharged or sold substandard goods or services" (CMS, 2015). The federal Anti-Kickback Statue is designed to protect patients and federal health care programs from fraud and abuse. It states "that anyone knowingly and willfully offer, pay, solicit, or receive any remuneration directly or indirectly to induce or reward referrals of items or services reimbursable by a Federal health care program" (CMS, 2015)."The

In order to more fully delve into this issue, this literature review will be focusing on three main areas of study as it applies to the topic of Medicare/Medicaid reimbursement and its relation to the Affordable Care Act. These areas of focus will include

Are you aware of the various policies that are being enacted from each state to state regarding the qualification of Medicare? Medicare is funded by the federal government and each state is responsible for operating the

Dual eligible beneficiaries are among the poorest and sickest of those covered by either Medicare or Medicaid and, subsequently, they account for a disproportionate share of spending in both programs. Yet unfortunately their care is disjointed, with little to no coordination. State and federal agencies, managed care organizations and advocates all agree that the misalignment between Medicare and Medicaid must be addressed. The varying rules, overlapping benefits and conflicting financial incentives between the two programs greatly affect the nearly 10 million beneficiaries nationwide who are dually eligible for both programs.

Medicaid provides a comprehensive benefit package for those who enroll. The federal government requires coverage of thirteen services, including inpatient and outpatient hospital services, nursing home and home health care, and for children under the age of twenty-one. The benefits do not end there, Medicaid offers a

The growing concern regarding the financial security of Medicare is one of particular interest to the nearly 72 million baby boomers that become eligible for this government-assisted, and tax-payer bolstered, program over the next two decades. According to the U.S. Census Bureau (2010), there will be a rapid increase in baby-boomers between 2010 and 2030, as the entire baby boomer population move into the 65 years and over category (p.3). Political and financial revisions must be made to ensure the security of Medicare as the numbers of individuals paying into this program are soon to be surpassed by the number of individuals drawing-off this program (U.S. Census Bureau, 2010). The elderly are also at a disadvantage with transportation to health care visits, picking up prescriptions, and rehabilitation services. There needs to be an establishment of access not only to primary care providers, hospitals, and rehabilitation services, but access to other aspects of the health care system for the elderly population.

The higher cost of affordable Health care is also eroding the ease with which to afford other insurance that covers about 30 percent of Medicare enrollees ‘expenses. In 2005, about 89 percent of beneficiaries obtained such additional coverage, including through former employers (33 percent), medical policies (25 percent), Medicare advantage plans (13 percent), Medicaid (16 percent), or other programs (1 percent) (MedPAC). These supplemental insurance programs were all very helpful at the onset, but with the passage of time and as health care costs continued to rise, employers are finding it difficult to support these programs and as a consequence, a greater number of these employers are either reducing the benefit or eliminating these benefits especially those that affects their retirees thereby increasing the cost of these supplemental insurances.