Wadannan dokoki suna kare ku daga zamba, sharar gida, da zalunci
Yawan kuɗin da aka rasa a yaudarar Medicare kowace shekara yana da ban mamaki. Ba kawai likitoci bane. Magunguna, asibitoci, kamfanonin inshora, dakunan gwaje-gwaje, ma'aikatan jinya, magunguna, mutane a kan Medicare-duk wanda zai iya yin zamba. Har ma fiye da zubar da zalunci da zalunci. Bambanci shi ne cewa cin zarafin ya haɗa da makircin makirci, yayin da ɓarna da zalunci, ko da yake ba da gangan ba, haifar da kalubale marasa amfani ga tsarin kula da lafiyarmu.
Sanarwar Tallafin Ciniki na Asibiti
Dubi wadannan lokuta daga shekara ta 2017. Abin takaici, mafi yawan sun biyo baya.
- A cikin Fabrairun 2017, an yanke wa wani mai kula da asibitin New York hukuncin shekaru biyar a kurkuku, kuma ya cajin dala miliyan 8 a cikin fansa bayan da ya biya marasa lafiya marasa lafiya don shawo kan gwaje-gwaje masu gwaji marasa lafiya a Medicare da Medicaid .
- A cikin watan Mayu 2017, masu sayarwa na Medicare Advantage sun yarda da yarjejeniyar dalar Amurka miliyan 32 bayan da aka nuna cewa asirin likitoci sun yi amfani da su wajen sa marasa lafiya su kasance marasa lafiya fiye da yadda suke, wanda hakan ya haifar da karin farashi daga gwamnati.
- A cikin watan Yunin 2017, Farawa Healthcare ya biya dala miliyan 54 don magance cajin game da biyan kuɗi don kula da marasa lafiya da kuma kulawa.
- A cikin watan Yulin 2017, Ma'aikatar Shari'a ta kaddamar da nauyin dalar Amurka biliyan 1.3 da suka shafi Medicaid da Medicare. 57 likitoci, 162 masu jinya, da kuma 36 pharmacists da aka dakatar da duk shirye-shiryen kiwon lafiya na tarayya don opioid diversion da zagi.
- A watan Agustan 2017, an yanke wa likitancin likitancin shekaru 35 a kurkuku, kuma ya biya dala miliyan 268 domin cin amana da kuma cin amana da Medicaid da Medicare. Ya gurbata takardun likita don umurni da gwaje-gwajen likita marasa amfani.
- A cikin watan Oktoba 2017, an yanke wa likitocin New York kimanin shekaru 2.5 a kurkuku saboda shan jingina a cikin shirin Medicare na dala miliyan 100 tare da dakin gwaje-gwaje a New Jersey.
Dalilin da ya sa cin hanci da rashawa ta kasance matsala
Akwai iyakacin kudi na Medicare. Ba wani asiri ne cewa asusun Medicare Trust yana da tsammanin za a kashe ta daga shekara ta 2028. Ƙasar Amurka ba zata iya rasa duk wani kudaden na ba don cin hanci da rashawa da kuma zalunci. Wannan shine dalilin da ya sa gwamnatin tarayya ta kafa doka ta yanke hukunci ga wadanda ke amfani da tsarin kiwon lafiyar da kuma dawo da kudi.
Waɗannan su ne dokokin, yadda suke aiki, da azabar su. Lura cewa azabtarwa suna ƙarƙashin kumbura.
1 -
Anti-Kickback Dokar (AKS)Menene?
An sanya shi a karkashin Tsare-gyare na Tsaro na 1972, Dokar Kuskuren (42 USC § 1320a-7b (b)) ya hana musayar (ko bayar da musanya) wani abu mai daraja (misali cin hanci, kickbacks, ragi) don masu neman sabis an biya su ta hanyar shirin kiwon lafiya na tarayya.
Misali
Kamfanin ƙwaƙwalwar zuciya zai iya ba da likitan kwalliya a kickback don yin karin jinya tare da na'urori.
Menene Sakamakon Sakamakon?
Kuskuren laifuffuka na iya hada da har zuwa $ 25,000 na kickback da / ko kuma shekaru biyar na kurkuku. Ƙungiyoyin lalata na iya zama kusan $ 50,000. Masu zanga-zanga na AKS kuma za a cire su daga shiga cikin shirye-shiryen kiwon lafiya na tarayya don akalla shekaru biyar.
2 -
Dokar Hukunci ta Tarayya (CMP)Menene?
Dokar Laifin Kuɗi na Ƙasar (42 USC § 1320a-7a) ta jawo laifin cin zarafi game da sababbin ka'idoji na Anti-Kickback (AKS). Baya ga magance matsalolin, gyare-gyare ga doka ta Dokar Kulawa da Kasuwanci ta musamman ƙetare ketare don shirya sabis tare da ƙungiyoyi waɗanda aka cire daga shirye-shirye na tarayya, yin maganganun yaudara a kan aikace-aikace ko kwangila tare da shirye-shirye na tarayya, samar da ƙaryar ƙarya, rashin rahoton saɓo, da kasawa don bawa gwamnati damar isa ga bayanai.
Misali
Medicare na buƙatar takardar lissafi don takamaiman kwanan wata, amma ofishin likitan ba ya sa bayanan likita a lokaci.
Menene Sakamakon Sakamakon?
Cunkulan bil'adama sun kasance daga $ 10,000 zuwa $ 50,000 dangane da cin zarafi. Har ila yau, masu laifi suna iya biya biyan kuɗin har zuwa sau uku adadin da ba'a dace ba.
3 -
Dokar Shari'a (FCA)Menene?
Dokar Sashin Karya, kamar yadda muka sani a yau, ya dogara ne akan gyaran da aka yi a 1986 a shekarar 1863. Har ila yau an san shi da Dokar Lincoln, ya fara a yayin yakin basasa lokacin da damuwa game da makircin makirci don sayar da kayayyaki zuwa Ƙungiyar Tarayyar. Dokar da ta haramta kowa daga yin watsi da shaidar karya ko cin zarafi ga gwamnatin tarayya don biyan kuɗi.
Misali
Wani likitan ilimin lissafi ya ba da lissafi don cin gashin fata wanda bai taɓa yin ba.
Menene Sakamakon Sakamakon?
Sakamakon faɗuwar jama'a (31 USC § § 3729-3733) yana da iyaka daga $ 10,781 zuwa $ 21,563 da iƙirarin, da sau uku lalacewa gwamnatin tarayya ta ci gaba saboda cikewar ƙarya. Laifuka na laifi (18 USC § 287) sun hada da ɗaurin kurkuku da laifin aikata laifuka har zuwa $ 250,000 ga mutum da $ 500,000 ga wata ƙungiya ga kowane da'awar.
4 -
Dokar Shari'a ta Laifin LafiyaMenene?
Dokar Shari'a ta Laifin Lafiya (18 USC § 1347) wata tanadi ne na Dokar Tsaro ta Jama'a wanda ya sa ya zama felony don yin niyya (ko ƙoƙari ya kashe) wani makirci don ɓata tsarin amfanin lafiyar lafiyar ko amfani da maganganun ƙarya don samun kudi daga wani shirin kiwon lafiya na tarayya.
Misali
Wani likitan kantin magani ba ya bayar da adadin kwayoyin kwayoyin kwayoyi ga marasa lafiya. Maimakon haka, yana juya kwayoyi don sayarwa kai tsaye ga sauran abokan ciniki.
Menene Sakamakon Sakamakon?
Kuskuren laifuffuka na iya haɗawa har zuwa $ 250,000 kuma / ko ɗaurin kurkuku har zuwa shekaru 20.
5 -
Dokar Stark (Lissafin Kalmomi na Kai tsaye)Menene?
Dokar Stark (42 USC § 1395nn) ta haramta likita daga yin masu neman hidimar kiwon lafiya ga mahalli idan likitan (ko dangi na iyalinsa) yana da mallaka / zuba jari ko tsarin tsarar kudi.
Misali
Wani likita ya kira marasa lafiya tare da COPD zuwa kamfanin samar da iskar oxygen mallakar matarsa.
Menene Sakamakon Sakamakon?
Dole a biya duk biyan kuɗin daga irin waɗannan masu biyan kuɗi zuwa ƙungiyoyi masu dacewa. Za a iya azabtar da $ 15,000 na kowane sabis da aka bayar. Har ila yau za'a iya samun kyautar $ 100,000 don shiga cikin tsari marar doka. Ana iya cire masu laifi daga tsarin shirin Medicare gaba daya.
Kalma Daga
Biliyoyin daloli ana biya daga Medicare da Medicaid kowace shekara. Ko dai cin hanci ne da ganganci ko ɓata da kuma zalunci ya faru ba tare da gangan ba, akwai dokokin da za su kare su daga asarar kuɗin kuɗi kuma su hukunta waɗanda suke kuskuren karɓar kudi daga gwamnati.
Abinda muke bukata shine aiwatar da waɗannan dokoki. Makomar Asusun Aminci na Medicare ya dogara da shi.
> Sources:
> Lafiya da Lafiya a shekarar 2017: Jerin gudu. Asusun kiwon lafiya. http://www.healthcarefinancenews.com/slideshow/biggest-healthcare-frauds-2017-running-list. Updated Nuwamba 10, 2017.
> Ƙarfin Ƙarƙashin Ƙari na Medicare. Office of the Inspector General. https://oig.hhs.gov/fraud/strike-force/.
> Cin hanci da rashawa, lalacewa, da zalunci: Rigakafin, Sano, da Bayyanawa. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/fraud_and_abuse.pdf. An buga Satumba 2017.
> Bayar da Kayan Kayan Likita. Cibiyoyin Kula da Magungunan Magunguna da Magunguna. https://www.cms.gov/Medicare/Fraud-and-Abuse/PhysicianSelfReferral/index.html. Updated Janairu 5, 2015.
> Mahimmin hanya ga sababbin likitoci: Cin zamba da zalunci. Office of the Inspector General, Ma'aikatar Lafiya na Amurka da kuma Ayyukan Dan Adam. https://oig.hhs.gov/compliance/physician-education/01laws.asp.