I WAS ASSIGNED TO DO OPTION 1.
Fraud Surveillance
By Day 1 of Week 1, your instructor will assign each student an option. In healthcare, federal and state laws including, but not limited to the HealthCare Fraud Statute, False Claims Act and Red Flags Rule address different components of fraud. In health information technology, an important component is policies and procedures to monitor abuse or fraudulent trends.
Option 1: Research the Health Care Fraud Statute and prepare a policy to monitor abuse or fraudulent trends. A policy should include:
- Title
- Date created
- Purpose
- Definitions
- Policy
- Procedures (You are not required to prepare the procedure for this option)
- Future Information (You are not required to prepare the future information for this option)
- References
Guided Response: Your initial post should be a minimum of 250 to 350 words and should explicitly address each component of your assigned option. Post a minimum of two follow-up responses to peers by Day 7. Each peer response should be a minimum of five full sentences and include a suggested addition or modification. Include a minimum of two references, other than textbooks, in APA format as outlined by the Writing Center Links to an external site.. Your three required posts must be on three different days of the week.
Expert Solution Preview
Introduction:
The Healthcare Fraud Statute is an essential component of healthcare regulation that addresses fraudulent and abusive trends in healthcare. In this assignment, we will prepare a policy to monitor abuse or fraudulent trends. The policy should cover various components, including title, purpose, definitions, policy, procedures (not required for this option), future information (not required for this option), and references. This policy will provide a framework for healthcare professionals to monitor and detect fraudulent or abusive trends, thereby promoting transparency and accountability in the healthcare industry.
Title: Policy to Monitor and Detect Healthcare Fraudulent Activities
Date created: DD/MM/YYYY
Purpose: The purpose of this policy is to establish a framework for monitoring and detecting fraudulent or abusive trends in healthcare services. The policy aims to ensure that healthcare professionals comply with the Healthcare Fraud Statute and other relevant healthcare regulations.
Definitions:
Fraud: Fraudulent activities refer to intentionally misrepresenting information, facts, or figures to gain profits or benefits in healthcare services.
Abuse: Abusive activities refer to practices that are inconsistent with accepted professional medical and healthcare practices, leading to unnecessary costs, improper billing practices, and poor quality of healthcare services.
Healthcare providers: Healthcare providers refer to licensed professionals who provide healthcare services, including physicians, nurses, dentists, pharmacists, and other medical professionals.
Policy:
The policy provides the following guidelines to monitor and detect fraudulent or abusive trends:
1. Healthcare providers must comply with the Healthcare Fraud Statute and other relevant healthcare regulations.
2. Healthcare providers must maintain accurate and complete records of medical services provided, including diagnosis, treatment, and billing information.
3. Healthcare providers must identify and report any suspected fraudulent or abusive activities to the appropriate authorities promptly.
4. Healthcare providers must establish a system to monitor and detect fraudulent or abusive trends in healthcare services.
5. Healthcare providers must train all employees on identifying and reporting suspected fraudulent or abusive activities.
Procedures:
This policy does not require procedures. However, healthcare providers must establish procedures for the monitoring and detection of fraudulent or abusive trends, as per the Healthcare Fraud Statute and other relevant regulations.
Future Information:
This policy does not require future information.
References:
1. Department of Health and Human Services. (n.d.). Healthcare Fraud Statute. Retrieved from https://oig.hhs.gov/fraud/statutes/factsheet.asp
2. Federal Trade Commission. (n.d.). Red Flags Rule. Retrieved from https://www.ftc.gov/enforcement/rules/rulemaking-regulatory-reform-proceedings/red-flags-rule
