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Healthcare fraud describes to the intentional making of false statements of material facts so as to acquire a healthcare payment for which no entitlement would otherwise exist. The deliberate soliciting Cincinnati Bengals Hats , paying and acceptance of remuneration to induce referrals for services that get offered by Federal Healthcare Programs also gets considered as healthcare fraud. The intentional billing of services at a higher level than the actual service also gets seen as healthcare fraud. The victims of healthcare frauds include patients, insurance companies, healthcare workers and the government through its medical funding plan. Healthcare abuse describes the actions that are inconsistent with the accepted medical practice and directly or indirectly lead into unneeded expenses to the Medicare program. Examples of healthcare abuse include charging exorbitantly for services and supplies, billing for extra services that were not medically required Cincinnati Bengals T-Shirts , engaging in deceptive advertising and marketing, and misuse of codes on a claim.
The managers in healthcare institutions are responsible for ensuring that the employees in the organization are aware of the different healthcare frauds and abuses. It is also the task of the healthcare manager to ensure that the workers are not committing the various fraud schemes and abuses.
It is the responsibility of a healthcare manager to ensure that the unit, service, division and the entire institution results in high performance. The manager has to ensure that the institution meets the predefined goals and objectives for service and the organization as a whole. The manager ensures that performance measures set in governance and strategic management Cincinnati Bengals Hoodie , clinical quality, financial planning, information services, human resources and planning and marketing get accomplished. The five primary phases in the performance management process include the setting objectives Customized Bengals Jersey , measuring the performance, comparing performance with objectives, identifying the cause of deviation and undertaking the suitable corrective action.
The manager is responsible for developing and retaining the employees with excellent performance. The employee performance puts into consideration their practices on issues concerning healthcare fraud and abuse. The approaches used by managers to improve employee performance include providing training and education programs, engaging workers to assess employee satisfaction Cheap Bengals Jerseys , providing leadership development programs, and determining employee needs. The healthcare manager is responsible for supervision, monitoring and reviewing employee鈥檚 performance and undertaking management functions in the institution so as to ensure that healthcare fraud and abuse does not take place (Buchbinder & Shanks, 2011). Some of the functions that the manager ensures that the Health Information Management professionals undertake properly include proper documentation of care information by capturing it accurately and timely. The manager should also educate employees as well as ensure that they are aware of the requirements for coding and documentation as defined by governmental Michael Jordan Womens Jersey , regulatory and professional agencies.
The managers need to be available to give guidelines as well as clarifications regarding confusing issues about healthcare fraud and abuse regulations. It is also the responsibility of the manager to give assistance to healthcare professionals and facilities so as to prevent healthcare fraud and abuse such as preventing billing mistakes.
The manager should undertake self-monitoring procedures so as to avoid any possible healthcare fraud and abuse. The managers should ensure that all healthcare workers are cognizant of the organization鈥檚 treatment, referral and billing practices (Kavaler & Alexander, 2012).
The manager should contract services of compliance firms that specialize in training healthcare workers on recognizing the different kinds of frauds, how to avoid them and their adverse impacts to the health care sector. It ensures that health care providers are aware of fraud as well as prevents the personnel from committing frauds without fully recognizing it as a criminal activity (Austin & Wetle Renell Wren Womens Jersey , 2012).
There are various steps that a manager should follow to correct a fraud and abuse case that gets discovered among the employees of a particular healthcare institution. It is essential that each institution adopts a corporate compliance plan that provides specific guidelines on how to handle fraud and abuse cases. The manager should first review and investigate the reported fraud and abuse case. This step allows the manager to gather sufficient and accurate information concerning the case. The information gathered then gets analyzed, and