Mitemo iyi inokudzivirira kubva pakubiridzira, kuparadza, uye kushungurudzwa
Nhamba yemari yakarasikirwa neukwereta hweMedare gore negore inoshamisa. Haisi kungovachiremba chete. Vanachipatara, masangano echipatara, makambani einishuwarenzi, laboratories, vanachiremba, vanachiremba, vanhu veMedare-chero ani zvake anogona kuita ucheve. Kunyanya kuisa dongo uye kushungurudzwa. Musiyano ndeyekuti kunyengera kunosanganisira chirongwa chekuda, asi kusvibisa uye kushungurudzwa, kunyange zvisingaiti nemaune, zvinokonzera mari dzisingakoshi kuhutano hwedu hwehutano.
Anozivikanwa Medicare Mhosva dzekunyengera
Tarisa pazviitiko izvi kubva muna 2017. Zvinosuruvarisa, zvakawanda zvakajeka kutevera.
- MunaFebruary 2017, muridzi wekliniki yeNew York akatongerwa makore mashanu mujeri uye akaraira $ 8 mamiriyoni muzvikwereti mushure mekubhadhara vanhu vasina pokugara kuti vawane mishonga isingakoshi inoshandiswa kuMedarendi neMedicaid .
- MunaMay 2017, vaviri veMedare Advantage vatsigiri vakagamuchira mamiriyoni makumi maviri nemamiriyoni ekugadzirisa mushure mekunge mumwe munyori akaraira kuti mabhuku ezvokurapa akashandiswa kuita kuti varwere vaone sevanorwara kupfuura ivo, zvichiita kuti vawedzere mari kubva kuhurumende.
- Muna June 2017, Genesis Healthcare yakabhadhara $ 54 Mamiriyoni kuti agadzirise zvinokonzerwa nebhadharo yekutarisira zvisina kufanira nekuchengetedzwa kwekuvandudza.
- Muna July 2017, Dhipatimendi reRuramisiro rakabvisa $ 1.3 bhiriyoni ring ringoronga Medicaid uye Medicare. 57 vanachiremba, vanamukoti 162, uye varemistri 36 vakarambidzwa kubva kumapurogiramu ese ehutano ehutano hwekutsvaga maopioid uye kushungurudzwa.
- MunaAugust 2017, chiremba weTexas akatongerwa makore makumi matatu mujeri uye akabhadhara madhora 268 mamiriyoni ekurangana nekunyengera kweMedicaid uye Medicare. Akanyora zvinyorwa zvezvechiremba kuti ape chirongwa chisina kufanira chekurapa uye mabasa.
- Muna Gumiguru 2017, vatatu vekuNew York vanachiremba vakatongerwa makore maviri mujeri nekuda kwekutora matanho mune $ 100 Milliare Scheme scheme nekambani ye laboratori muNew Jersey.
Sei Uchifunga Kunyengera Ndiyo Nyaya
Kune mamiriyoni emari Medicare mari inowanikwa. Hazvisi chakavanzika chokuti Medicare Trust mari inotarisirwa kuti ibudirire muna 2028. United States haigoni kukwanisa kurasikirwa chero ipi yeyo mari iyo kubiridzira, kuparadza, uye kushungurudzwa. Ndicho chikonzero hurumende yehurumende ine mutemo panzvimbo yekuranga avo vanoshandisa hutano hwehutano uye kuti vape mari yakarasika.
Aya ndiwo mitemo, maitiro avanoita, uye chirango chavo. Ndapota cherechedzai kuti zvikwereti zvinotungamirirwa nekutengesa.
1 -
Anti-Kickback Statute (AKS)Chii ichochi?
Yakagadzirirwa pasi peSocial Security Kuvandudzwa kwa192, Anti-Kickback Statute (42 USC § 1320a-7b (b)) inorambidza kutengesa (kana kupa kugoverana) chero chinhu chinokosha (p., Zviokomuhomwe, kukanganisa, zvikwereti) zvekutumira mabasa inobhadharwa nehurongwa hwehutano hwehutano.
Muenzaniso
Imwe kambani yemagetsi inogona kupa chirodiologist chigadziriswa kuti aite upiyona hwakawanda nemapurisa avo.
Ndeipi Mhosva?
Zvikwereti zvemurairo zvinogona kusanganisira chikwereti kusvika madhora makumi maviri nemakumi maviri nemakumi matanhatu kubva pamatambudziko uye / kana makore mashanu mujeri kwenguva. Zvikwereti zvehurumende zvinogona kunge zvakakura se $ 50,000. Vadzvinyiriri veAAC vachadzingwawo kuti vasabatanidzwa muhurongwa hwehutano hwehutano kwemakore anenge mashanu.
2 -
Mari Yehurumende Mhosva Yakaitwa Mutemo (CMP)Chii ichochi?
Nhepfenyuro yeMari Yehurumende Mutemo (42 USC § 1320a-7a) inokonzera kurangwa kwehurumende nekuda kwekuputsa kweAnti-Kickback Statute (AKS). Mukuwedzera pakutarisana nekukanganisika, kuchinjwa kwemurairo neChinakidza Care Act inonyatsorongedza vapanduki kuburikidza nekugadzirisa mabasa nemasangano asina kubviswa kubva kuhurongwa hwehurumende, achiita zvinyorwa zvenhema pamaitiro kana zvibvumirano zvine mapurogiramu ehurumende, achiita mhaka dzenhema, asingakwanisi kubhadhara mari yakawanda, uye kukundikana kupa hurumende kuwanikidzika kwenguva yakareba kune zvinyorwa.
Muenzaniso
Medicare inokumbira chati yekuongorora kune rimwe zuva, asi hofisi yechiremba haina kuita kuti marenda ezvehutano anowanikwa panguva.
Ndeipi Mhosva?
Zvizvarwa zvehurumende zvinotangira kubva ku $ 10 000 kusvika ku $ 50,000 zvichienderana nekuputsa. Vadzvinyiriri vari pasi pekubhadhara kukanganisa kusvika katatu mari iyo inenge isingatauri.
3 -
Mhosva yeZvenhema (FCA)Chii ichochi?
Icho Chirevo Chezvokutaura Nhema, sezvatinoziva nhasi, chinobva muna 1986 kuchinjwa kwemurairo wepakutanga wakapfuura muna 1863. Uyewo unozivikanwa seMutemo weLincoln, yakatanga kusvika panguva yeHondo yeVanhu paiva nehanya pamusoro pezvirongwa zvekubiridzira kutengesa zvinhu Union Army. Uyu mutemo unorambidza munhu kubva pakuzviisa pasi achiziva nhema kana kuti zvinyengeri kune hurumende yehurumende kubhadhara.
Muenzaniso
A dermatologist inotumira mushumo weganda rechivara raasina kumboita.
Ndeipi Mhosva?
Zvirango zvehurumende (31 USC § § 3729-3733) zvinobva pa $ 10,781 kusvika ku $ 21,563 pamhosva, uye katatu zvinokanganisa hurumende yehurumende yakasimbiswa nekuda kweshoko rehema. Zvikwereti zvemurairo (18 USC § 287) zvinosanganisira kuiswa mujeri nemhosva yemhosva kusvika kumadhora mazana maviri emakumi mashanu evanhu uye $ 500 000 kune imwe kambani kune imwe neimwe inodanwa.
4 -
Utano Hwemhosva Nechirwere ChekunyengeraChii ichochi?
Dare reCriminal Health Care Fraud Statute (18 USC § 1347) inopa rubatsiro rweSocial Security Act rinoita kuti rive ruvengo kurwisa (kana kuedza kuita) chirongwa chokubiridzira chirongwa chekubatsirwa kwehutano kana kushandisa zvinyorwa zvenhema kuti uwane mari kubva chirongwa chehutano hwehutano.
Muenzaniso
Mumwe mushandi haatauri nhamba yakakodzera yemapiritsi epipiyadhi kumurwere. Pane kudaro, anotsausa mapiritsi ekutengesa zvakananga kune vamwe vatengi.
Ndeipi Mhosva?
Zvikwereti zvemurairo zvinogona kusanganisira chikwereti kusvika ku $ 250,000 uye / kana kuiswa mutorongo kusvika makore makumi maviri.
5 -
Stark Statute (Chiremba Self-Referral Law)Chii ichochi?
The Stark Statute (42 USC § 1395nn) inorambidza chiremba kubva pakugadziriswa kwehutano kune imwe sangano apo chiremba (kana nhengo yemhuri yake) ane unhu hwekuita / wekutsvaga mari kana urongwa hwekubhadhara.
Muenzaniso
Chiremba anoreva varwere vane COPD kune kambani inopa oxygen iyo inowanikwa nemudzimai wake.
Ndeipi Mhosva?
Zvose zvikwereti kubva kune izvozvi zvinotumirwa zvinofanira kubhadharwa kumapato akakodzera. Chirango che $ 15,000 chinogona kuiswa kune imwe nheyo inopiwa. Ikoko kunogona kunge kune $ 100,000 yakanaka yekupinda mune zvisiri pamutemo. Vadzvinyiriri vangave vasiri kubviswa purogiramu yeMedare.
Shoko Rinobva
Mabhiriyoni emadhora anoshandiswa kunze kweMedareid uye Medicaid gore negore. Pasinei nokuti unyengeri hunoitwa nemaune kana kuti kuparadza uye kushungurudzwa kunoitika zvisingazivikanwi, pane mitemo iri munzvimbo yekudzivirira kune izvo zvinorasikirwa nemari uye kuvhara avo vanoita zvisina kunaka mari kubva kuhurumende.
Zvatinoda ndezvekusimbisa mitemo iyoyo. Nguva yemberi ye Medicare Trust Fund inoenderana nayo.
> Sources:
> Utano Hwenhema Nokugara mu 2017: Running List. Healthcare Finance. http://www.healthcarefinancenews.com/slideshow/biggest-healthcare-frauds-2017-running-list. Yakapedzwa musi waNovember 10, 2017.
> Medicare Sokubiridzira Simba Simba. Office of the Inspector General. https://oig.hhs.gov/fraud/strike-force/.
> Medicare Kunyengera, Matsi, uye Kushungurudzwa: Kudzivirira, Kuziva, uye Kuzivisa. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/fraud_and_abuse.pdf. Yakabudiswa muna September 2017.
> Physician Self Referral. Nzvimbo dzeMedare uye Medicaid Services. https://www.cms.gov/Medicare/Fraud-and-Abuse/PhysicianSelfReferral/index.html. Yakapedzwa musi waJanuary 5, 2015.
> Nzira Yomugumo yeNew Physicians: Mishonga Yokunyengera uye Kushungurudza. Office of the Inspector General, US Department of Health and Human Services. https://oig.hhs.gov/compliance/physician-education/01laws.asp.