Assignment
Introduction
Introduction To Evolving Healthcare Reform
It is most important that any program of compliance be kept current with regular review and updating. Compliance officers and committees must take the time to carry out such reviews and critiques and revise any policies and procedures that have failed to provide the needed compliance. Discipline must be applied whenever called for by written policies and procedures, so that all personnel will take seriously the requirements set out in such policies
Objectives
To successfully complete this learning unit, you will be expected to:
• Identify corrective methodologies to improve processes.
• Explain how to develop strategies from an audit program.
• Determine the importance of updating compliance plans.
• Enumerate the benefits of implementing changes in processes.
• List the various types of training programs.
• List the various levels of disciplinary actions.
• Define the components of a due diligence notification.
• List the elements required on a disciplinary action form.
• Contrast the appropriate punishment for each level of violation.
Discussion
Answer the following questions:
• Identify the type of facility in which you work or would like to work. Go to the Internet and list all the sources you might use to keep your compliance plan up to date.
• Explain why a due process letter is important to issue.
Case Assignment
Please read and choose one of the following case studies:
Case study on page 205 of your textbook.
Case study on page 213 of your textbook.
p.205
"We used the office of the inspector general (OIG), office of audit services (OAS) RAT-STATS variable appraisal for stratified samples to estimate the amount of unallowable program payments. We reported the estimate of unallowable program payments at the lower limit of 90-percent two-sided confidence intervals in accordance with OAS policy"
p.213
"On October 16,2006 in Los Angeles, CA, Lourdes ‘Lulu' Perez, a registered nurse who once owned the two largest home health agencies in California, was sentenced to 46 months in prisonfor her role in defrauding Medicare out of $40 million and for filing false tax returns that concealed her ill-gotten gains. Additionally, Perez was sentenced to three years supervised release and ordered to pay$6,127,374 to Medicare and $874,336 to the IRS; she has already repaid approximately $34 million to the government. According to court documents, Perez orchestrated a scheme in which her company obtained patients by paying illegal kick-backs to marketers; doctors and patients and then billed Medicare for services that were not medically necessary, and in some cases not performed at all, and created false medical records to support fraudulent claims and avoid detection of the fraud by Medicare contractors. The scheme ran from October 2002 to September 2003, when the federal authorities seized more than $20 million in assets from Perez and Medicare suspended further payments to her agencies" (https:///www.oig.hhs.gov)
Provide an explanation for the choice you made.
Your paper must address the following:
Address problem of the case decision.
A thorough analysis including resources.
Detailed comprehensive realistic recommendation.
Supplements with extensive compelling evidence from legitimate sources.
Sources cited correctly in the body of the case and reference page.
Attachment:- Lecture_Notes.pdf