Understand Fraud And Abuse Laws In Health Care

The Canadian Health Information Management Association Code of Ethics outlines a powerful standard for Health Information Management Professionals. When one becomes a member of CHIMA along comes the responsibility of following the code of ethics as faithfully and professionally as possible. Although the interpretation of the guidelines can vary among individuals and organizations, the basis and underlying meaning of each code should be synonymous. The ten codes set general expectations for HIM professionals that help the public understand the ethical views of CHIMA. With these ethics in place we are able to decrease the number of breaches, improve data quality and encourage lifelong learning. There are a number of breaches that occur in healthcare settings that go unreported on a daily basis. The reason for these cases going unreported could be the lack of knowledge of severity and consequences, or have a malicious intent. The case study is a definite breach of the CHIMA code of ethics- and could fall into numbers 1-10, but in my opinion is more relevant to numbers 2-3, 5-7 and 9. Jane should have acted in a more proactive manner reflecting CHIMA values and informed the appropriate individuals so that they correct actions could be made.

Health care fraud and abuse are one of the U.S healthcare system biggest problems, which affect everyone either directly or indirectly. Billions of dollars have been lost due to health care fraud and abuse. With a number of losses, this can lead to increase in health care costs and potential increased of coverage.

1.1 Identify legislation and codes of practice that relate to handling information in health and socail care

1. Identify legislation and codes of practice that relate to handling information in health and social care.

identify legislation and codes of practice that relate to handling information in health and social care

Medicare and Medicaid fraud has some strengths as well as weaknesses. A strength that comes with healthcare fraud is The Affordable Care Act. This act helps to fight health care fraud, abuse and waste (Department of Human Services, 2014). Many laws have been implemented to help commit those people that have been committing Medicare and Medicaid fraud. Per the Center of Medicare and Medicaid services website “The Affordable Care Act increases the federal sentencing guidelines for health care fraud offenses by 20-50% for crimes that involve more than $1 million in losses, establishes penalties for obstructing a fraud investigation and makes it easier for the government to recapture any funds acquired through fraudulent practices” (Department

Fraud and abuse encompasses the actions of fraud, abuse, and waste in the health care system (McWay, 2014). It is a nationwide problem that affects all of us and can be committed by anyone. Schemes can be committed by a single person or a by an institution or group. The National Health Care Anti-Fraud Association (NHCAA) estimates that

The purpose of this paper is to bring awareness to the issue of healthcare fraud and abuse. I feel that healthcare fraud and abuse is one of the biggest issues in healthcare. So, this paper will get everyone to be able to spot fraud before it happens. During, the process you will be able to identify what a person organization did that was fraud or how they abused healthcare rules. This paper will explain to you what exactly healthcare fraud and abuse is and how it affects everyone around us. Throughout this paper, we will examine 3 different articles related the healthcare fraud and abuse and provide a summary and analyze them.

The table below sets forth HCFAC funding, by agency, for health care fraud and abuse control activities in FY 2014, including sequester reductions. The FBI also receives a stipulated amount of HIPAA funding for use in support of the Fraud and Abuse Control Program, which is shown below. Separately, CMS receives additional Mandatory Resources under the Medicare Integrity Program (section 1817(k)(4) of the Social Security Act). The inclusion of the activities supported with these funds is not required in this report, and this information is included for informational purposes.

We should focus on treatment, not punishment… OIG report suggests prescribers are not checking the databases, or databases lack current data. What’s their training?

One of the main concerns in a fraud investigation is the analysis of facts and evidence. It is important to bear in mind that every fraud investigation is unique, as each fraud has its own set of facts and details. The investigator must be objective in her or his work and has to determine whether or not there is actually evidence of a fraud. Evidence of health care fraud includes patient medical records, computer files in processing the claims with Medicare, written or printed sources such as claim form, Medicare enrollment application, financial and billing data. It also includes testimony received from interviews of the witnesses or the patients themselves, bank records (personal and business account), and the explanation of benefits statement

Healthcare fraud is costly for everybody, as it harms the reputation of the institution or physician committing it, and financially damages the patient being affected.By definition fraud may be defined as intentionally employing surprise, trickery, cunning, deception and unfair ways by which one party cheats another party out of financial resources. In order to educate a healthcare manager regarding fraud , many aspects of fraud must be assessed. This includes the types of fraud, the consequences that come with fraud,the individual(s) committing them, techniques to prevent fraud, and why the healthcare industry is vulnerable to fraud.

The department of Health and Human Services protects and guides the health and well being of individuals here in America (Thacker, 2014). They fulfill these duties providing Americans with adequate and efficient health and human services and monitoring services designed to increase the efficiency of care in the health system (Thacker, 2014). One of the services being monitored by the department of Health and Human Services is the electronic health record system, which carries private and vital information of patient’s health record enabling all eligible participating health workers access to these records (Thacker, 2014). A breach of the protective health information of patients in a health organization creates chaos as these are against the health insurance portability and accountability (HIPAA) law (Thacker, 2014). Hence, measure will have to be put in place to determine what caused the breach and how to rectify it to ensure the breach never happens again (Thacker, 2014).

HIS is a department in health care delivery system. Before now it is believed that health information professionals are to work harder and smarter. Later on it was discovered that working smarter is better than working harder.

Over the years, computer technology and the internet has made a drastic change around the world for healthcare industry. The healthcare industry is continuing to give positive changes for patients and employees thanks to computer technology. It has made it easier and more productive for patients and employees. Now patients can feel more at ease during their doctor’s visit because of the benefits of technology.