Question

What is one law that has been enacted that is included in the chapter and discuss why it is or isn't an effective stop-gap to health care fraud and abuse.

Health Care Management Third edition Buchbinder & Shanks

Answer 1

Healthcare management is one of the fastest growing sectors in today's times. Due to expansion and diversification the healthcare industry is expected to grow manifold. Buchbinder and Thompson has defined healthcare management as "those entities and organizations who provide direct care to the patients, resident or clients who all try to get sercies from the organization".

There are two aspects of healthcare management industry

Direct care as the word suggests directly providing Healthcare services to the patients by healthcare managers.

Non-direct care means those settings that are not directly involved in providing care to the patients but rather provide facilities and products that enable the direct care providers to take care of the patients effectively.

Healthcare managers are those people who plan, organize, direct, staff and control the care that has to be provided to the patients in the direct as well as indirect care settings.

I believe the Criminal-Disclosure Provisions of the Social Security Act would not be an effective stop-gap method for healthcare fraud and abuse because it is up to the physi- cians to disclose overpayments and if not done, they must be caught in order to pay a penalty for nondisclosure. Because of the responsibility of the provider to disclose this information if they are knowingly committing fraud they aren’t going to tell the govern- ment of the overpayments.