Anti kickback laws help in safeguarding payment for certain healthcare services and are standardized and the possibility of bribe or any form of impunity is deterred and on occurrence it is liable to prosecution in a court of law (Altshuler, Creekpaum & Fang, 2008).
Such laws are referred to us safe harbors and compliance to their provisions is voluntary while non compliance is taken to be a case that one can be prosecuted for. However they are important in detecting fraud in Medicaid and Medicare insurance services and their relevance is to enhance accountability. Although this being the case organizations that are not certain of the legitimacy of such practices can ask for advisory opinions from the government anti-kickback regulation’s office to avoid such aftermath cases as stated by the Office of Inspector General (1999). False claims acts and kickbacks avoidance to either sale made to practitioners or to hospitals must be enhanced to help ensure transparency in the medical insurances. Public fraud is an abuse of treasure that is owed by the government and has got stipulated penalties since it is a crime. This paper takes a keen focus on the different kinds of abuse that can occur and the different recommendations on how to curtail them.
Laws governing Medicaid against fraud and abuse
The requisites listed in anti bribery bodies to ensure that Medicaid practice is only done by specialists who are in the competent capacity to perform. As Altshuler, Creekpaum and Fang (2008) state laws on ambulatory centers of surgery which restricts the practice to specific gastroenterologists, surgeons and certain physicians has been stipulated prevent incompetent medical practice. Laws stipulating that there should be transparent and competent appointment of practitioners in underserved areas are also provided though still remain of concern due to their vulnerability to kickbacks, disguised payments for referrals for ones financial benefit, their recruitment and their retaining criteria has become tricky calling for intervention through frequent monitoring to prevent the abuse of these insurances through fraud. Laws stipulating the subsidies reduced on obstetrical immoral conduct, trends of selling physician practices and investment in groups in terms of referral arrangements, cooperation in delivering hospital services and ultimately the explanation for shared risks and clarifications of these laws have been provided as observed by Office of Inspector General (1999). According to Altshuler, Creekpaum and Fang (2008) the statutory laws have given a mandate to charge persons for deception, fabricated representations such as in cases of accidents, claims of lost patient and substandard services which were offered particularly if it has proof to validate such claims. Stringent protocols are followed when giving such penalties; these can be either in the form of a fine, an incarceration and also a limitation for services by such federal programs henceforth (US Federal News Service, 2006). Giving of hush money in exchange for certain services and incentives such as discounts arrangement to speed up your consultations, inductive referrals and acquisition of a specific kind of treatment at will are heavily punished. These laws are meant to foresee the future of these insurances particularly due to increased cost which does not reflect proficient services offered consequently inducing questions to the government on performances of such programs. The virtues of transparency and reduced impunity being the major focus of the Medicaid and Medicare though they remain their biggest nightmares thus reduced impacts of these insurances in healthcare.
Concerns and abuse found in this case
The law concerning joint ventures has been overstepped since it permits an upper limit of physician investors of about 50% while in essence this proposal has gone beyond since it is 60% (Altshuler, Creekpaum and Fang, 2008; Staman, 2010). This is deliberate since the motives are to maximize the profits gained. Considering it is located in a community hospital the possibility of being in an underserved area is minimal and does not have about 75% underserved patients. This means that the feasibility of this proposal is minimal and illegal according to the provisions of the law thus no need to progress with implementing it. This investment is also endangered since under the stipulated laws only solo practitioners are protected by the safe harbors thus it can be in more danger of failure if it incorporates a new partner minding that it has overstepped some of the laws. These laws state that no one will be excluded from these laws even under certain circumstances. Concerns about a proposal to give staff remuneration in the form an additional monthly bonus and also some staff privileges in return for furnishing this illegal agreement is unethical and against the law. It may cost these individuals a fine or even and imprisonment since this portrays they are conscious that this arrangement is unlawful (US Federal News Service, 2006). The arrangement of leasing should be done in light with the knowledge of the federal state but for this case it is questionable since it is being done furtively.
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