Applicaiton Paper Health Finance

APPLICATION PAPER –HEALTH CARE FINANCE |

|

|

Karlene Rambaran |

DeVry University

Professor: Mary Black

Subject: HSM 340 –Health Care Finance

Date Submitted: September 06th, 2013

APPLICATION PAPER –HEALTH CARE FINANCE

What are five elements pertaining to the establishment of a false claim under the False Claims Act?

The False Claims Act was introduced in March of 1963, to prevent people /organizations from defrauding the government and it also gives an incentive award to anyone who brings information to the government about fraudulent activities.

* A claim has to be submitted knowingly by the healthcare provider.

* If the government wants to prove that the claim was submitted knowingly, they must establish that the health provider had knowledge of the claim submission.

* If someone knowingly makes or uses a false record or fraudulent claim from the government. For example a doctor submits a bill to Medicare for services that were not performed.

* The Government needs to present a preponderance of evidence to establish its case.

* Any claim that is submitted with the intent to defraud is fined anywhere from $5,500 to $11,000 per claim and more than that including the damages caused to the federal program. (Cleverly, Song, & Cleverly, 2011).

HIPPA Privacy Standards

The main purpose of the HIPPA Privacy Rule is to protect the privacy of the patient’s health information from unauthorized users. The major objectives of interest are:-

* Define and limit the circumstances in which entities that are subject to the standards (covered entities) may use and disclose protected health information.

* Establish certain individual rights regarding protected health information and

* Require covered entities to adopt administrative safeguards to protect the confidentiality and privacy of protected health information.(Cleverley, Chapter 4)

APPLICATION PAPER –HEALTH CARE FINANCE

Stark Law II

The Stark Law was...