Malamulo awa amakutetezani ku chinyengo, kuwononga, ndi kuzunza
Kuchuluka kwa ndalama zomwe zinatayika ku chinyengo cha Medicare chaka chilichonse ndi zodabwitsa. Sikuti ndi madokotala okha. Amayi a chipatala, ma chipatala, makampani a inshuwalansi, ma laboratories, anamwino, asayansi, anthu omwe amagwiritsa ntchito Medicare-aliyense akhoza kuchita chinyengo. Ambiri amawononga komanso amazunza anzawo. Kusiyanitsa ndiko kuti chinyengo chimaphatikizapo chiwembu, koma kuwononga ndi kuchitira nkhanza, ngakhale osati mwadzidzidzi, kumabweretsa ndalama zosafunikira kuntchito yathu yaumoyo.
Nkhani Zowononga Zamagetsi Zodziwika
Yang'anirani milandu iyi kuyambira 2017. Tsoka ilo, zambiri zatsimikizika kuti zitsatire.
- Mu February 2017, mwini wa kampani ya chipatala cha New York anaweruzidwa kuti akhale m'ndende zaka zisanu ndipo adalamula madola 8 miliyoni pa zilango pambuyo powapatsa anthu opanda pakhomo kuti ayesedwe mankhwala osagwiritsidwa ntchito ku Medicare ndi Medicaid .
- Mu May 2017, a inshuwalansi awiri a Medicare Advantage adavomereza ndalama zokwana madola 32 miliyoni pambuyo poti wolemba milandu adawonetsa kuti zolemba zachipatala zinagwiritsidwa ntchito kuti odwala aziwoneka odwala kuposa momwe analili, zomwe zimapangitsa kuti abwerere ku boma.
- Mu June 2017, Genesis Healthcare adalipira madola 54 miliyoni kuti athetse milandu yokhudzana ndi kubwezera kwa chisamaliro chosafunikira ndi kuchikonzanso.
- Mu July 2017, Dipatimenti Yachilungamo inaletsa ndalama zokwana madola 1.3 biliyoni zokhudzana ndi Medicaid ndi Medicare. Madokotala 57, anamwino 162, ndi osamalima 36 analetsedwa ku mapulogalamu onse a zachipatala omwe amachititsa kuti opioid azisokoneza komanso kuzunza anzawo.
- Mu August 2017, dokotala wa ku Texas anaweruzidwa kuti akhale m'ndende zaka 35 ndipo adalandira $ 268 miliyoni chifukwa chokonza chiwembu ndi Medicaid ndi Medicare. Iye adanyalanyaza zolemba zachipatala kuti apange mayeso ndi zofunikira zachipatala zosafunikira.
- Mu October 2017, madokotala atatu a New York anaweruzidwa kukhala m'ndende zaka 2.5 chifukwa chotsatira ndondomeko ya madola 100 miliyoni a Medicare ndi kampani ya laboratory ku New Jersey.
Chifukwa Chodziwiratu Chinyengo Ndi Nkhani
Pali zochepa za Medicare ndalama zomwe zilipo. Si chinsinsi kuti thumba la Medicare Trust likuyembekezeredwa kukwanilitsidwa ndi 2028. United States silingakwanitse kutaya ndalama iliyonse kuti iwononge, kudula, ndi kuzunza. Ndicho chifukwa chake boma limapereka malamulo kuti athe kulanga anthu omwe amagwiritsa ntchito chithandizo chamankhwala ndikubwezeretsa ndalama.
Awa ndi malamulo, momwe amagwirira ntchito, ndi zilango zawo. Chonde dziwani kuti chilangocho chikukhudzidwa ndi kutsika kwa mitengo.
1 -
Chilamulo Chotsutsa Kick (AKS)Ndi chiyani?
Kuchitidwa pansi pa Social Security Amendments a 1972, Chigamulo cha Anti-Kickback (42 USC § 1320a-7b (b)) chimaletsa kusinthanitsa (kapena kupereka zopatitsa) chilichonse chofunika (mwachitsanzo, ziphuphu, ziphuphu) amalipidwa ndi pulogalamu ya federal.
Chitsanzo
Kampani yogwiritsira ntchito mtima ingapereke katswiri wa mtima kuti ayambe kuchita opaleshoni zambiri ndi zipangizo zawo.
Kodi Chilango Ndi Chiyani?
Zilango za chilango zingaphatikizepo ndalama zokwana madola 25,000 potsatizana ndi / kapena zaka zisanu za ndende. Chilango cha boma chikhoza kukhala choposa $ 50,000. Otsutsa a AKS sadzathenso kupezeka nawo pazinthu zaka zisanu ndi zisanu.
2 -
Chigamulo cha Zigawo za Chigamulo (CMP)Ndi chiyani?
Lamulo la Chigamulo cha Ndalama Zachikhalidwe (42 USC § 1320a-7a) limapereka chilango cha boma chifukwa cha kuphwanya lamulo la Anti-Kickback (AKS). Kuwonjezera pa kuthetsa vutoli, kusintha kwa lamulo la Affordable Care Act makamaka kumalimbikitsa ophwanya malamulo pokonzekera mautumiki ndi mabungwe osatchulidwa ku federal mapulogalamu, kupanga mauthenga achinyengo pa ntchito kapena mgwirizano ndi mapulogalamu a federal, kupanga mabodza onyenga, kulephera kupereka malipiro owonjezereka, ndi kulephera kuti apatse boma nthawi yowonjezera mauthenga.
Chitsanzo
Medicare akupempha kafukufuku wa tchati tsiku linalake, koma ofesi ya dokotala siimapanga zolemba zachipatala panthawi yake.
Kodi Chilango Ndi Chiyani?
Zilango zapachiŵeto zimachokera pa $ 10,000 mpaka $ 50,000 malinga ndi kuphwanya. Otsutsana amatha kulipira ngongole katatu kuchuluka kwa ndalamazo.
3 -
Chilamulo Chachinyengo Chachinyengo (FCA)Ndi chiyani?
Lamulo Lotsutsa Malamulo, monga tikulidziwira lerolino, likukhazikitsidwa ndi kusintha kwa 1986 ku lamulo loyambirira lomwe linaperekedwa mu 1863. Lachitonso limatchedwa Lincoln Law, lomwe linayamba kale pa nthawi ya Nkhondo Yachibadwidwe pamene kunali kudandaula za ndondomeko zachinyengo zogulitsa katundu Union Army. Ndilo lamulo loletsa aliyense kuti adziwitse mwachinyengo mabodza kapena zabodza kwa boma la federal kuti lilipire.
Chitsanzo
Dermatologist imapereka chikalata cha chikopa cha khungu chimene sanachitepo.
Kodi Chilango Ndi Chiyani?
Chilango cha boma (31 USC § § 3729-3733) chimachokera pa $ 10,781 mpaka $ 21,563 pa chigamulo, kuphatikizapo katatu kuwononga kwa boma la federal chifukwa cha zabodza. Chilango cha milandu (18 USC § 287) chimaphatikizapo kumangidwa ndi kulipira ndalama zokwana madola 250,000 kwa $ 500,000 ndi $ 500,000 kwa bungwe la aliyense.
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Chigwirizano chaumoyo wachinyengoNdi chiyani?
Bungwe la Criminal Health Care Fraud Statute (18 USC § 1347) ndilo bungwe la Social Security Act lomwe limapangitsa kuti achite (kapena kuyesa kuchitapo kanthu) njira yonyenga pulojekiti ya phindu lachipatala kapena kugwiritsa ntchito mawu olakwika kupeza ndalama kuchokera pulogalamu yachipatala ya federal.
Chitsanzo
Wamasamba samapereka chiwerengero choyenera cha mapiritsi a opioid kwa wodwala. M'malo mwake, amachotsa mapiritsi kuti athe kugulitsa kwachindunji kwa makasitomala ena.
Kodi Chilango Ndi Chiyani?
Chilango chophwanya malamulo chikhoza kuphatikizapo ndalama zokwana madola 250,000 ndi / kapena kutsekeredwa m'ndende zaka 20.
5 -
Stark Statute (Chigwirizano Chodziletsa Kwachipatala)Ndi chiyani?
Stark Statute (42 USC § 1395nn) imaletsa dokotala kuti asatumize mautumiki a zaumoyo ku chipatala pamene dokotala (kapena membala wa banja lake) ali ndi chiwongoladzanja kapena chiwongoladzanja.
Chitsanzo
Dokotala amatchula odwala omwe ali ndi COPD ku kampani yopereka oksijeni imene ili ndi mkazi wake.
Kodi Chilango Ndi Chiyani?
Malipiro onse ochokera kwa oterewa ayenera kubwezedwa ku maphwando oyenerera. Chilango cha $ 15,000 chikhoza kuperekedwa pa ntchito iliyonse yoperekedwa. Pakhoza kukhala ndalama zokwana madola 100,000 zokhala ndi malamulo osaloledwa. Otsutsa akhoza kuchotsedwa pulogalamu ya Medicare kwathunthu.
Mawu Ochokera
Mabiliyoni a madola amaperekedwa kuchokera ku Medicare ndi Medicaid chaka chilichonse. Kaya chinyengo chimachita mwachangu kapena kuwononga ndi kuchitiridwa nkhanza zimapezeka mosayembekezereka, pali malamulo omwe angapezeke kuti ateteze kuwononga ndalama zomwezo komanso kuti awononge anthu omwe amachititsa molakwa ndalama ku boma.
Chimene tikusowa ndikutsatira malamulo amenewo. Tsogolo la Medicare Trust Fund likudalira pa izo.
> Zotsatira:
> Zopangira zachinsinsi ndi malo okhalamo mu 2017: Mndandanda wa Kuthamanga. Healthcare Finance. http://www.healthcarefinancenews.com/slideshow/biggest-healthcare-frauds-2017-running-list. Idasinthidwa November 10, 2017.
> Mankhwala Opondereza Okhwima. Ofesi ya Inspector General. https://oig.hhs.gov/fraud/strike-force/.
> Medicare Chinyengo, Kutaya, ndi Kuzunzidwa: Kuteteza, Kuzindikira, ndi Kuyankha. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/fraud_and_abuse.pdf. Lofalitsidwa September 2017.
> Dokotala Wodzipatula. Maofesi a Medicare ndi Medicaid Services. https://www.cms.gov/Medicare/Fraud-and-Abuse/PhysicianSelfReferral/index.html. Idasinthidwa pa January 5, 2015.
> Mapu a Njira Zatsopano kwa Achipatala Achilendo: Malamulo achinyengo ndi Mavuto Olakwika. Ofesi ya Inspector General, US Department of Health and Human Services. https://oig.hhs.gov/compliance/physician-education/01laws.asp.