Fraud and Abuse Flashcards
Why is there so much fraud/abuse with federal payers?
Retrospective payment system - they pay and then chase because hard to keep track of 40M claims and complex system
Section of Social Security Act (SSA) can exclude or ban individuals from participating in federal healthcare programs directly or indirectly. E.g., any organization which administers Medicare or Medicaid is banned from hiring or contracting excluded individuals or entities.
Exclusion Statute
HC professionals most banned from providing care to Medicare patients d/t defaulting on student loans?
Chiropractors and dentists
A legal provision added into a statute or regulation that provides protection from legal liability when certain conditions are met.
Safe Harbor
Example of Safe Harbor in Physician Self Referral Law (Stark Law)
In-office Ancillary Services Exception (IOAS Exception) - self referral is allowed if PT in house
HIPPA: what is allowed and what is not
Initial signed consent covers:
- treatment and sharing info b/t professionals who share patient like MRI results, and private communication
- Health operations like QA and outcome tracking
- Payment like insurance and billing
Everything else requires special signed consent
Transforming society by optimizing movement to improve the human experience
Newest vision adopted in 2013
What type of direct access does CO have
Unrestricted Direct Access
No restrictions or limitations whatsoever for treatment absent referral in 20 states
Unrestricted direct access
