National Healthcare Fraud

In adherence  with the  CMS efforts to sustain  data security and  data integration efforts,  HCRS are able to “conduct  clinical coding reviews,   collect, standardize and validate coding practices  and also provide  reviewer provider activities and audit claims , identifying overpayments and training requirements, reimbursements requirements and recovery  ”(Program Integrity, 2009)

They are also able to conduct audit that ensure the data integrity and consistent  and have also developed a software tool called  the ecoder that enhances the ability of auditors to document their coding in real time and helps them in  producing individual case summaries  provider summaries  and overall  audit statistics. ”(Program Integrity, 2009)

HCRS also provide training services for their clients in compliance with the HIPAA    and health information technology for their end users. (Health Information Technology and Management Services, 2009)

Conclusion

Organizations and criminals who make fraudulent claims cases are  experts in their fields and the government have  to use the latest technologies and  specialised services  to ensure  the prevention FWA.  

The finances saved by the government by preventing frauds and through recoveries, can be used in implementing programs for the improvement of health care services and benefits for the citizens of USA.

FWA prevention has to be a collaborative effort between the private, public and government sector to be effective. Compliance with CMS, HHS and DOJ to prevent fraud may seem tedious at the individual level but should meticulously complied with,   as the benefits are reaped by the entire community.

References

1.      Corr, W. (2009, Oct 28 ) Effective Strategies for Preventing Health Care Fraud . Retrieved from http://www.hhs.gov/asl/testify/2009/10/t20091028a.html

2.      Department of   Health and Human Services. (2009). Justification   of Estimates for Appropriations Committees.  Retrieved from http://www.cms.hhs.gov/PerformanceBudget/Downloads/CMSFY09CJ.pdf.

3.      Health Care Associations of New York State (2009, Dec 11).Quality Improvement Organizations and Initiatives . Retrieved  from http://www.hanys.org/leadership_library/

4.      Health Care Resolution Services. (2009). Program Integrity. Retrieved   from http://www.hcrs-inc.com/home/services/program_integrity/. 

5.      Hill, T (2007, March  07). Testimony before the Subcommittee on Health
of the House Committee on Ways and Means.[Press Release]. Retrieved from http://waysandmeans.house.gov/hearings.asp?formmode=view&id=5580

6.      Hill, T (2007, March 08). Medicare Program Integrity. [Press Release .Retrieved from http://www.cms.hhs.gov/apps/media/testimonies.asp.

7.      Hill, T. (2007, July 17).Medicare Healthcare Fraud & Abuse Efforts.[Press Release]

Retrieved from http://www.hcrs-inc.com/home/services/health_information_technology/

8.      New West Health Services. (2009).Medicare Advantage and Part D Compliance Training 2009  Retrieved from www.newwesthealth.com/uploads/PDF/provider/MA_FWA_2009.ppt

9.      Robles, A.M (2009, May 20)  Healthcare Fraud and Abuse with Suggested Compliance Plan. Retrieved from   http://bitteroak.seasunlife.com/wp-content/uploads/2008/05/healthcare-fraud-and-abuse-_2_.pdf

10.  SafeGuard Services LLC. ( 2009 ). How Does  the PSC Differ from QIO .Retrieved from http://www.edssafeguardservices.eds-gov.com/faqs.asp