Ihofisi ye Inspector General (OIG) yakagadzira uye yakabudisa zviyeuchidzo zvekunyengedza kune vekuchengetedza utano hwevanhu. Izvi zviyeuchidzo zvakafanirwa kuparidzira tsika dzenyika dzekubiridzira kuvanhu vose. Iyowo nzira yekupa ruzivo uye kuziva nezvekuita kweukanganisa mukati mebhizimisi uye kukanganisa kwekodzero chaiyo kuMedareri uye Medicaid Anti-Kickback Mutemo.
Medicare neMedicaid Anti-Kickback Mutemo
Mutemo weAn anti-Kickback unogadzirisa kutora uye kuvhara munhu upi zvake ane mhosva yekuita zvimwe zvido zveutano mukugadzirisa mari. Zvigadziro zvakakura asi zvinowira mukati mezvikamu zviviri:
- Chero kushandiswa kwemari kunobatsira kutumirwa kweumwe munhu chero ipi zvayo inobhadharwa pasi pe Medicare kana Medicaid program
- Chero kushandiswa kwemari kunotungamirira kukutenga chero chinhu chipi zvacho chinotengwa pasi peMedareri kana Medicaid program
Zvikwereti zvekuputsa mutemo weAnti-Kickback zvinogona kuva zvakanyanya. Kurwisana nemutemo weAn anti-Kickback inopomerwa nehurumende iyo inogona kuguma nemari yepamusoro ye $ 25,000 pamhosva yepamusoro uye / kana kuti kuiswa mujeri kwemakore mashanu. Mukuwedzera kune mubhadharo uye kuiswa mutorongo, vateresi vanogonawo kuiswa kunze kwekubatanidzwa muHurumende yehutano hwehutano. Kana imwe nguva mupiki asina kubatanidzwa kubva muHurumende yehutano yehutano, mutapi haachagoni kuwana mhirizhonga yemabasa chero ipi zvayo akaitwa kana zvinhu zvakagadzirirwa varwere.
Izvi zvinosanganisira maitiro akaitwa kana zvinhu zvakagadzirirwa kutungamirirwa kana mutemo wekuregererwa mupiki.
Special Fraud Alerts
IOIG yakatumidza nzvimbo shanu dzingaratidza kutyora kwemutemo unopesana nemhosva. Hazvirevi kutarisirwa kune chimwe chinangwa kunze kwekuona basa rinonyengera.
- Urongwa Hwokutaurirana Hwokutengeserana: Chero humwe hutano hwakabatana hwakagadzirirwa kuwana ruzivo rwekutumirwa kubva kune vashandi vezvechiremba umo vanobhadharwa nenzira isina kukodzera kunogona kuva mubvunzo. Cheropi chiremba anobhadhara mari kubva kune anotumira anogona kuronga kana kuita mabasa asina basa anokosha kumapurogiramu e Medicare uye Medicaid.
- Waiving Copayments kana Deductibles: Zvichida kubhadharwa mari kana kubhadhara kuvarwere veMedare pasina kugadzirisa dambudziko rezvemari zvinowanikwa mukushandiswa kwakanyanya kwebasa rakabhadharwa neMedare. Mupiki anogona kukurudzira vatendi kuenda kune zvimwe zvinhu kana maitiro asina mushonga asingakoshi. Varwere vanoda kuita maererano nokuti zvinhu uye zvibvumirano zvakasununguka.
- Chipatara Chinokurudzira Vanachiremba: Munhizha inokura nokukurumidza, vanachiremba vanogona kuoma kuunganidza nekuchengetedza. Zvipatara izvo zvinoshandiswa pakukwezva vanachiremba nemakwikidziro chaiwo zvinoreva kuti chiremba anoendesa varwere vake vose kwavari. Ichi chisarudzo chichange chakavakirwa pamutungamiri wezvemari panzvimbo yehutano hwekutarisira.
- Chirongwa cheDhipatimendi reDrug Marketing: Vanachiremba kana mashizimusi vanobvuma zvipo kana mari yekutsinhanisa mukurondedzera varwere vavo vane mishonga chaiyo yemishonga vari kutora matambudziko nekutarisira kwavo. Mishonga yakapiwa kuvataradzi kuchinja mishonga kubva mune chimwe chigadzirwa kusvika kune imwewo inoratidza chiratidzo chekuzvibata.
- Clinical Lab Services: Mune zvimwe zviitiko, kunze kwebhakatoti rinogona kupa vanachiremba, zvipatara kana mamwe mabasa ehupi anonyanya kuisa kunze kwehuwandu hwemagariro avo kana zvibvumirano. Inogona kuonekwa semubatsiro mukutsinhana kwekutumira kune laboratory.
Reporting Information
Kuti ubatsire kuderedza udzvinyiriri, OIG inokumbira kuti utaure neDhipatimendi reZvipatano neHuman Services kana eHhovisi yeApector General nemashoko iwe unogona kuva nawo pamusoro pemunhu chero upi zvake anobata pane zvingave zvisiri pamutemo kutarisira utano.
Sources:
Brown, June Gibbs. Inspector General Notice. The Office of Inspector General. Dhipatimendi reUnited Health Health and Human Services. Musi waDecember 2, 1994, www.oig.hhs.gov.