Question

2. For what kinds of violations could a physician or other practice employee be subject to criminal penalties? 3. What kinds of health-care related financial investments should a physician avoid? 4. Explain the terms "upcoding", "unbundling". "clustering", "program exclusion", and "whistle- blower" 5. What is the purpose of a "baseline" claims audit in establishing a compliance program? Dashboard Calendar To Do Notifications Inbox

Answer 1

2. According to Health Insurance Portability and Accountability Act of 1996 (HIPAA) has set up regulations to maintain the confidentiality of patient’s information. Criminal penalties for HIPPA violations are made:

1. Unknowingly
2. With a reasonable cause
3. Under false pretense
4. For any personal gain

Physicians are also penalized for crime of medical negligence.

3. The health care business ventures with outside parties such as imaging centers, laboratories or physical therapy clinics wherein the physician has financial self interest. It has been observed that physicians who had invested in such health care business ventures refer more patients to the vendors than other physicians who do not. Hence, these business relationships distort the ethical decision-making of the physicians.

NOTE- Please post the other questions in different threads in Chegg portal.