HSM546 Course Discussions Week 5

$9.50

HSM546 Course Discussions Week 5
Describe the role of state government in the regulation of managed care…

SKU: HSM 546 Legal Issues Fraud Abuse Discussions Week 5 Keller Categories: , Tags: , , ,

Description

HSM546 Course Discussions Week 5

HSM546 Course Discussions Week 5

All Students Posts – 91 Pages 

Legal Issues – 43 Pages 

Discuss the clauses and provisions that should be included in provider contracts.  What is the function of contract law? Describe the role of state government in the regulation of managed care.  You’ve heard the saying “that contract is not worth the paper it’s printed on.” A contract is a memorialized agreement between the parties. The real value of a contract comes into play when it is challenged in court.  The elements of a contract include: Mutual Assent -Offer and acceptance, Consideration, Intent…

Fraud and Abuse – 48 Pages 

What steps should be taken to mitigate exposure and liability when the federal government shows up to audit a healthcare organization?  There are a number of civil and criminal statutes that deal with false claims. The Medicare and Medicaid fraud and abuse law; the mail fraud statute 18 U.S.C.A. §1341; laws prohibiting persons from knowingly making or presenting false or fraudulent claims to the U.S. government, 18 U.S.C.A. §287; statutes prohibiting the making of false or fraudulent statement or representation, 18 U.S.C.A. § 1001; and wire fraud, 18 U.S.C.A. § 1343; Secondary offenses such as aiding and abetting, 18 U.S.C.A. § 2, conspiracy, 18 U.S.C.A. § 371; and theft of government property, 18 U.S.C.A. § 1961-68 are also some possible charges. And let’s not forget the RICO statutes.  So you can see that the government does not take fraud and abuse lightly.  So what can you do before an audit to reduce liability for your organization?  Some folks have mentioned a compliance officer.  What would be the duties of this compliance officer?  The main question is titled fraud and abuse but there is a difference – what is that difference?