Medicare Billing Violations
I think it’s wrong for the government to penalize physicians for not meeting compliance standards. However, It’s a great opportunity for the government to aim at small practices because this is where physicians are self-employed. These types of physicians have numerous clinic or health care facilities and are most likely to commit fraud. This seems kind of biased, but it’s true. According to, Ornstein, the most common sanctions are against physicians who have odd Medicare billing reputations (2014, title). In the text, the levels of violations are warnings, an informal disciplinary action, punitive action, and termination (Safian, 2009, pg. 218.). For a physician billing Medicare wrongfully the first time they could receive a warning. The second
Critical Access Hospitals: Case Summary And Analysis
511 Words | 3 PagesThe existing law also has the ability, to give the board powers to put him or her on probation depending on the conditions. Therefore, information obtained from the MBC, in fiscal year 2015-2016, received 8,679 complaints against physicians and surgeons and unlicensed individuals alleged to be practicing medicine without a license. These complaints include allegations including excessive prescribing, gross negligence/incompetence, licensee self-abuse of drugs or alcohol, convictions of a crime and general unprofessional
Guy Ross Health Care Fraud Case
216 Words | 1 PagesPage 1 of 2 Caterra Bruno05/17/2018HS115A medical assistant was sentenced today to 36 months in prison for his role in a conspiracy to defraud the Medicare program, the Departments of Justice and Health and Human Services announced. Guy Ross was also sentenced by U.S. District Judge Denise Page Hood in the Eastern District of Michigan to three years of supervised release following his prison term and was ordered to pay $472,623 in restitution. Ross, 51, pleaded guilty in July 2010 to one count of conspiracy to commit health care fraud. According to court documents, Ross received kickbacks from the owners and/or operators of two Detroit-area home health agencies, Patient Choice Home Healthcare Inc. and All American Home Care Inc., in exchange
Bylaws And Rules Of Advanced Practice Professional Medical Assistant
1072 Words | 5 Pages“Automatic Suspension of Privileges” means suspensions that are automatically (administratively) enacted whenever the defined indication occurs, which warrants a suspension of privileges, and does not require discussion, investigation of clinical care concerns, or result from concern of substandard care, professional misconduct, or professional incompetence. Examples include exceeding the allowed medical record delinquency rate when such delinquency does not impact patient care or failure to maintain qualifications for appointment, extended sick leave, or other extended leave. Privileges are automatically suspended until the cause of the suspension has been addressed such as the records are completed, or the delinquency rate falls to an acceptable level, or provider returns to duty. Reactivation must be endorsed by the Medical Executive Board and discussion of reactivation should include consideration of a Focused Professional Practice Evaluation (FPPE) depending upon length of time away from practice and reason for the automatic
HIPAA Compliance Risk Analysis
1369 Words | 6 PagesThe Health Insurance Portability and Accountability Act (HIPAA) is a vital part of the health care industry’s day to day business. HIPAAs procedures define how healthcare companies receive and handle their clients’ health care information. HIPAA helps to protect the patient’s personal information through confidentiality and security procedures while being transferred, handled or shared with other healthcare providers (Modifications to the HIPAA Privacy, Security, Enforcement, and Breach Notification Rules, 2013). When a patient’s privacy is not regulated, third parties could buy and sell the information without the patients’ authorization. With HIPAA being in place, it prevents healthcare employees from divulging any patient information they
Medicare Part D: Annotated Bibliography
1067 Words | 5 PagesMedicare Part D In Urban Health Planning class we often discussed about several topics related to the health care system. For this assignment we needed to examine two peer reviewed journal articles on the topic that we find interesting. I choose the topic Medicare because we all are going to be old someday and might need Medicare to support ourselves. Medicare is a health insurance program for a person older than 65 and also younger person who has disabilities.
Montana Code 50-602
753 Words | 4 PagesIn this case, criminal charges are established between healthcare organizations and the government. The punishment may involve a fine and/or imprisonment (McWay, 2014, pp.
Centers For Medicare Compliance Report
380 Words | 2 PagesAlso, CMS entered into an agreement with FMQAI – Florida Medical Quality Assurance, Inc to issue services for Medication Measures Special Innovation Project. Nevertheless, this project created measures to assist quality healthcare delivery to Medicare beneficiaries. There are five Centers for Medicare and Medicaid services Small Entity Compliance Guides. First, a guide has to be prepared when an organization gives final directives by preparing a Final Regulatory Flexibility Analysis under the Regulatory Flexibility Act. Second, organizations are desired to publish compliance guides on their websites, and share guides with affected individuals.
Medicare Policy Summary
1033 Words | 5 PagesMedicare is a tightly regulated US health insurance program that provides coverage to those who are 65 years or older, certain younger individuals with disabilities and those with end staged renal disease or amyotrophic lateral sclerosis. Medicare has four parts associated with it, one of which is Part B. Part B is also known as supplementary medical insurance and provides coverage to beneficiaries for outpatient care, preventive services, ambulance services, and durable medical equipment. Outpatient physical therapy services falls into this category of coverage for Medicare Part B (Jannenga, 2014). However, there are several rules and regulations that health care providers, including physical therapists, must follow in order to receive proper
Arguments Against The HIPAA Rule
372 Words | 2 PagesThe HIPAA rule is built to protect and prevent disclosing individuals’, and consumers’ identifiable health care information unlawfully and without getting authority from the concern parties. If someone break the law, individuals are subject to civil penalties of $100 on each violation but the penalty can accumulates based on numbers of violations; the standard maximum limit of civil penalties is $25,000 each person, each year (HIPAA Privacy Rule – What Employers Need to Know, n. d.). As per stacking rules, if a person violated two HIPAA standards, the penalty can be $50,000; Similarly, the criminal penalties subject to maximum of $ 250,000 and ten years in prison can be imposed to those individuals and parties who disclosed protected information
Medicare Billing Errors
151 Words | 1 PagesCatherine, I did not realize how important the modifiers were to the Medicare billing process. Since reading some of the discussions this week I understand the role of modifiers much better. It is essential that we are able to choose the correct modifier because it can avoid fraud and abuse. After doing a little research I found that one of the top billing errors is from choosing the incorrect modifier. Because every code does not require a modifier I 'm afraid I will have trouble determining which code needs a modifier and which ones do not.
Medicare Fraud Research Paper
301 Words | 2 PagesIf so, then you should contact the Medicare Fraud Reporting Center. You may be eligible for a financial
Pros And Cons Of Obamacare
757 Words | 4 PagesObamacare and medicare should be repealed. Being fined for not paying for an insurance you can not afford because of the obamacare and affordable care act is wrong in many ways and just another way that obamacare knocks our nation down one step at a time. It has made taxes of those in the middle class and upper class rise and cost more money for the insurance provided to the people after taking away their original insurance plans. Obamacare is not free insurance it is costing the people in the nation hurting those who have to pay more just to support the lower class
Medicare Part B Case Study
1442 Words | 6 PagesWhich under the current design addresses long- term care for a limited amount of time, such as for rehabilitation purposes. These services cannot be received outside of a Medicare-approved facility, which means the person cannot reside in their home and receive the long-term care assistance under the current system. Therefore, we propose to amend this portion of the program to extend the funding for long-term care to include home care. Which consist of the relatives receiving monetary compensation for their care. Under the current policy, 41% of the Medicare budget of $50,000,000,000 is being advocated this particular area.
Tort Case Study: Health Care Law
1368 Words | 6 PagesMissed identification of shock symptoms in Ms. Gadner 2. IV infiltration being missed resulting in her not receiving fluid ordered 3. “Scanty documentation” depriving the physician of information on Ms. Gadner’s current condition 4. Administration of valium and morphine, contraindicated in shock, nursing not questioning the order 5. Didn’t communicate need for transfer to Dr. Dick.
Health Care Stakeholders Analysis
1010 Words | 5 PagesThe facilities enforcing protocols and policies to secure that employees are meeting government regulations. Doctors, nursing staff and support staff I must use their best ethical and moral judge in most case to ensure patients are being retreated. Thus, sometimes causing conflict with health care administration because health care workers sometimes unknowingly break policies or protocol by putting patients first. As well as hospitals and clinics have so many departments that there can be conflict of interest with patient care that can cause inconsistency with patient care (Santilli, J. el al., 2015, Para
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