Question

The Patient Protection and Affordable Care Act (PPACA) of 2010 (section titled “Subtitle D”) identifies requirements relating to provider compliance with fraud, waste, and abuse laws. Identify three measures that your health care organization ((or health care organizations in general) has initiated, or could initiate, to comply with these measures. Support your analysis with a minimum of two peer-reviewed articles.

Answer 1

Healthcare fraud and abuse cases cost the industry billions of dollars a year. Without processes in place to detect and prevent fraudulent activities, healthcare providers could face an investigation that may cost them their reputation and revenue. However, developing appropriate healthcare fraud and abuse prevention policies and compliance programs may be difficult for provider organizations. Health care providers such as hospitals and doctors face a variety of legal risks: malpractice, tax, and fraud, waste and abuse. Recent cases have shown that fraud, waste and abuse exposure can dwarf the risk of malpractice and tax liability.

Six steps providers can take to minimize their fraud, waste and abuse risk

1. Cultivate a strong desire to prevent these
2. Follow the orders of higher authority and stick to the plan
3. Problems to be detected earlier and told to others
4. Resourses to be made easily available
5. A goal should be set for a year and acted accordingly
6. Encourage views of experienced personnels

Other steps to be taken by the health care provider are:

1. Auditing and monitoring
2. Background investigation
3. Awareness and training
4. Adequate agreements
5. On the go evaluation

Articles for reference:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2804462/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3001814/