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There are five elements pertaining to the development of a false claim in regards to False Claims Act. Firstly, in the case where the contract terms, regulation, statute or specification is violated (“How Far Does the False Claims Act Reach?”,(n.d.).). Also, false claim under the False Claims Act is established when services are offered as claimed while the claim by it self is false (“How Far Does the False Claims Act Reach?”, (n.d.).). Further more, a false claim is established if any claim submitted was originally obtained through any means of corruption or fraudulent conduct or fake statements or in violation of any statute under loan guarantee, contract or any other agreement (“How Far Does the False Claims Act Reach?”, (n.d.).). To add to the above, under the act [S. Rep. 99-345 at 9], the Act is arises when a contract is obtained through collusive bidding (“How Far Does the False Claims Act Reach?”, (n.d.).). Lastly, a violation may suffice as a result of failing to make sufficient inquiries about the meaning of unclear rules (“How Far Does the False Claims Act Reach?”, (n.d.).).
The three broad objectives of the HIPAA privacy standards are; Firstly, HIPAA is designed to protect the confidentiality of a person’s (“Hipaa privacy regulations”, (n.d).). E.g. obtaining a patients test results and disclosing the results to sneakers. Secondly, HIPAA is designed to protect all health. (“Hipaa privacy regulations”, (n.d).)..E.g. the patient’s information should never be leaked for whatever irrelevant purpose or person whatsoever. Lastly, HIPAA is designed to protect the patience privacy data (“Hipaa privacy regulations”, (n.d).). Should the doctor reveal the test results while a relative is there? If he/she does, he/she has violated the HIPAA rule.
Physician self referral refers to a situation where a physician refers a patient to an entity in a medical facility in which he or she have financial relationship e.g. ownership, investment, etc (“Centers for Medicare & Medicaid services”, (n.d).).
Specific designated health services (DHS) prohibited to physicians with financial connections with facilities offering DHS are laboratory services., Physical and occupational therapy services, pathology services, radiology services, radiation therapy services, medical equipment and supplies, prosthetics devices and supplies, remote health services, prescription drugs and inpatient / outpatient clinical services (“Home | Centers for Medicare & Medicaid Services”,(n.d).).
Qui tam action is where a person often referred to as a whistle blower brings a lawsuit against a company or person suspected to have violated a government regulation or the performance contract with the government (if a statute exists to and provides a penalty incase of such violations ) (“Legal Dictionary”, (n.d).).
HIPAA Privacy Rule is concerned with the use and disclosure of patients or Individuals Protected health Information (PHI) by relevant bodies subject to the privacy rule. The main goal of this rule is to ensure total protection of privacy of people and ensure a smooth flow of peoples’ information at the right place, time and to the right person / people for efficient health provision (“Summary of the HIPAA Privacy Rule”, (n.d).).
Emergency Medical Treatment and Active Labor Act was enacted in 1985. The main goal of this law was to prevent hospitals from transferring Medicaid patients to public hospitals prior to at least confirming through medical screening that the patient is stable for a transfer (“EMTALA”, (n.d.)).
Compliance program are the policies, systematic procedures, structures etc adopted by an organization to make sure that provisions of the regulations laid by the government agency are being met (“What is compliance program? definition and meaning”, (n.d).).
References
EMTALA. (n.d.). American College of emergency Physicians. Web.
Health Care Fraud: How Far Does the False Claims Act Reach?. (n.d.). Quackwatch. Web.
n/a. (n.d.). Hipaa privacy regulations. Web.
Physician Self Referral | Centers for Medicare & Medicaid Services. (n.d.). Home | Centers for Medicare & Medicaid services. Web.
qui tam action legal definition of qui tam action. qui tam action synonyms by the Free Online Law Dictionary.. (n.d.). Legal dictionary. Web.
Summary of the HIPAA Privacy Rule. (n.d.). United States Department of health and human services. Web.
What is compliance program? definition and meaning. (n.d.). Business dictionary.com – online business dictionary. Web.
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