The Patient Protection And Affordable Care Act

The existence of Affordable Care Act have been a promising act for millions of citizens, especially the effort to end homeless, to put low-income on a better care at a reasonable price, and the access to healthcare through a variety of healthcare insurance choices. Its’ purpose is to reform healthcare, creating new policies, and establishing a better accessibility to physician and hospital with a cost that fit within both side budgets. The Act guarantees subsidies to all patient with an offering to better practitioner and treatment options to create a strong incentives to improve the quality of cares and services (Meek, 2012, pg. 15). Nevertheless, The Affordable Care Act face many barriers such as

Health care fraud and abuse is a significant contributor to high health care spending, resulting in the wasteful spending of health care dollars. The Federal Bureau of Investigation (FBI) and National Health Care Anti-Fraud Association (NHCAA) estimates that 3 to 10 percent of health care dollars are lost to fraud and abuse (Federal Bureau of Investigation, 2010). Fraud is the intentional deception or misrepresentation that an individual knows to be false or does not believe to be true and makes, knowing that the deception could result in some unauthorized benefit to themselves or some other person (Ryan, 2006). Bloomberg reports health care expenditures are rising faster than the rate of inflation and spending in the US has nearly doubled in the last decade and one-half of health care

Questions are constantly circulating around the new Affordable Care Act. Many do not know what it does and the government is trying to make it out to be a big savior to the medical field for doctors and patients alike. The Affordable Care Act has also been given the name Obamacare because of its ties to the President. He believes that increasing the amount of people on insurances of any kind that meets his “standards” will help health care become more available and more profitable. Unfortunately, these claims are not true as Obamacare is clearly going to negatively impact health care in all aspects. The problems start for patients who get on government healthcare programs, such as Medicaid, with the fact that the treatment plans are extremely

The ACA is made up of a series of additions of and changes, to the multiple laws that are made up from the legal framework of the U.S. healthcare system. This act establishes the basic legal protections that have been nonexistent to the United States, will now guarantee access to affordable health insurance coverage for Americans, from when they are born, all the way through his or her retirement. The act hopes in cutting the number of uninsured Americans by more than half of the U.S. population (Rosenbaum, 2011, p.130). This law hopes to result in health insurance coverage for about 94% of the American population (Rosenbaum, 2011, p. 130). This will reduce the population of uninsured Americans by 31 million people, and increase Medicaid enrollment by 15 million recipients (Rosenbaum, 2011, p. 130). Approximately 24 million people are still expected to remain without a coverage plan. The act has several goals. For instance, one goal of the ACA is to have a close to universal coverage system, with the help and responsibility among individuals, employers, and largely, the government. The second goal is to improve the fairness, condition, and affordable prices of health insurance coverage for Americans (Rosenbaum, 2011, p. 130). Lastly, a third goal is to improve the quality of health care through value, excellence, and effectiveness while trying to reduce inefficient spending and making the healthcare system more reachable to a diverse population (Rosenbaum,

Charles, the Affordable Care Act (ACA) was intended to correct the historical issues related to cost and access in the health care system in America (Pagel, Bates, Goldmann & Koller, 2017). The ACA was an attempt by the US government to ensure access to health insurance was available for more Americans. The historical role of the government in health care prior to the ACA had been that the government should only have a little involvement in the delivery and reimbursement of services with respect to having a role in policy making for the protection of the public’s health (Williams & Torrens, 2008). The role of government involvement has changed through the Medicare and Medicaid government programs. Today, these programs have the

According to the Federal Bureau of Investigation (FBI) “health care fraud costs the country an estimated $80 billion dollars a year” ("Health Care Fraud," n.d., p. 1). Because health care costs continue to rise more rapidly than the rate of inflation the threat of health care fraud continues to rise. The Affordable Health Care Act has put new policies in place to identify and stop health care fraud. The FBI along with other government, insurance, and public agencies have joined together to combat fraud at every level. New rules in identifying, investigating, and prosecuting fraud before payments are made to medical providers could save billions of

The Patient Protection and Affordable Care Act of 2010 (ACA) is a new health care legislation law passed by the American government in 2012 to reform the United States health care system. All the states will enact this legislation, however, selected will limit the provision provided to their citizens (Kaiser Commisson, 2013). According to Spares, (2011), the ACA opens the door for many 47 million nonelderly uninsured Americans who have never been eligible for affordable health care insurance including many of the 1.8 million uninsured Georgians. The ACA health care reform law’s goal is to decrease the number of uninsured community and increase health care regulations so that health care quality increases in a cost efficient way (Sparer, 2011). Part of the ACA’s provisions will be to increase wellness care for a healthier America to prevent costly chronic disease treatment (Knickman & Kovner, 2015).

Attempts to stop fraud were enhanced under Public Law 104-191, the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The purpose was to improve the Medicare program under title XVIII of the Social Security Act, the Medicaid program under title XIX of such Act, and the efficiency and effectiveness of the health care system. This public law encouraged the development of a health information system through standards and requirements for the electronic transmission of certain health information (aspe.hhs.go). The Act established a program to take action against fraud committed against public and private health plans. The legislation required the establishment of a national Health Care Fraud and Abuse Control Program (HCFAC), under the joint direction of the Attorney General and the Secretary of the Department of Health and Human Services (HHS) acting through the Department 's Inspector General (HHS.gov). The HCFAC program is designed to coordinate Federal, State and local law enforcement activities with respect to health care fraud and abuse. The Act requires HHS and Department of Justice (DOJ) detail in an Annual Report the amounts deposited and appropriated to the Medicare Trust Fund, and the source of such deposits. (HHS.gov) I will summarize the impact of these laws as it pertains to how they are impacting the healthcare delivery system. (HHS.gov)

Collectively, the Department of Health and Human Services and the Department of Justice work to reduce healthcare fraud and investigate dishonest providers and suppliers. The Health Care Fraud Prevention and Enforcement Action Team recouped almost 3 billion in fraud, this year alone. Also, aggressive strategies exist to eliminate Medicare prescription fraud. Patients abusing or selling painkillers received by visiting several doctors and obtaining multiple prescriptions costs Medicare millions annually. Fraud affects everyone, preventing it requires government officials and citizens diligently working together.

In this paper you are going to learn all about the Accountable Care Organization (ACO). Also, how does it pertain to the healthcare system? We will also be learning about the reimbursement rates for Medicare patients. Who makes up the Accountable Care Organization? We will also take a look into the Affordable Care Act and how the ACO is a part of that.

The Affordable Care Act (ACA) is a complex federal law that affects health system of the United States in every aspect. ACA goals is to improve quality of healthcare; increase access, and to stabilize and possibly reduce the cost of the healthcare services. ACA provisions include, but not limited to, expansion of Medicaid to all individuals less than 65 years of age whose income is 133% of the Federal Poverty Line (FPL) or below; created Consumer Operated and Oriented Plan a nonprofit, member-run health insurance companies in all 50 states; prohibits existing health insurers to deny coverage due to preexisting conditions; allows states to create a Basic Health Plan for individuals without health insurance and income range of 133-200% FPL; improves prevention services by requiring health plans to include basic preventive coverage without cost-sharing; improve access to health care by providing additional funds for community based health centers and other community based organizations(Knickman, Kover, 2015. Pp344-361). Every provision of ACA will bring significant change to every area of the healthcare and, as a result, changes in access, quality, and cost. These 3 components of the healthcare system are intertwined and change in one will cause the change in the others.

Health care in the United States is driven by a patchwork of services and financing. Americans access health care services in a variety of ways — from private physicians’ offices, to public hospitals, to safety-net providers. This diverse network of health care providers is supported by an equally diverse set of funding streams. The United States spends almost twice as much on health care as any other country, topping $2 trillion each year. (WHO.INT 2000) However, even with overall spending amounting to more than $7,400 per person, millions of individuals cannot access the health care services they need.(Foundation 2009) So when the Patient Protection and Affordable Care Act (a.k.a the Affordable Care Act or ACA) was passed in the summer

Even although, the cost of the health care system and the care it offers my not allow the national debt to decline to a level that will or would enhance the economy forward the cost of running a system that is backed by the government is too costly, and it will not help the deficit. , the legal responsibility of the organization is that every patron should have the same treatment for the same ailment. There are no predetermined dispositions; everyone is eligible as a government-backed facility. The funds are to assure those who have no insurance are covered. The accountable care

Although Congress has used several anti-fraud measures to protect the federal government health care programs, the False Claims Act of 1986 has become the main weapon that government prosecutors use against perpetrators of health care fraud. Designed to prevent fraud and other abuses in federal government programs, the False Claims Act has been the primary statute the government has used in its fight against health care fraud. However, government prosecutors do not rely on one statute in their prosecution of alleged cases of health care fraud. Instead, they rely on a combination of statutes, but the False Claims Act has emerged as the main statutory weapon.

Insurance companies and the federal government should pool resources using a percentage of profits to finance a task force to arrestively fight fraud. The penalty for fraud should be more stringent which will cause perpetrators to think twice before formulating a plan to commit fraud. The Affordable Health Care Act is the beginning of many programs established to fight against fraud. Health care fraud is a growing problem and should be taken more seriously by citizens of the United States. Physicians, health care workers, and patients are responsible for