Answer:
Some of the laws governing Medicare Parts C and D Fraud, Waste, and Abuse (FWA) include the Health Insurance Portability and Accountability Act (HIPAA), the False Claims Act, the Anti-Kickback Statute, and the Health Care Fraud Statute and Criminal Fraud.
Explanation:
These laws governing Medicare Parts C and D Fraud, Waste, and Abuse (FWA) are released by the Centers for Medicare and Medicaid Services (CMS), they include code of conduct standards and policies, guidelines for handling complaints, and to coordinate enforcement deals between CMS and laws.
Fraud, Waste, and Abuse (FWA) control provides rules for part D plan sponsors on how to implement regulatory requirements to have in place a comprehensive fraud and abuse plan to detect, correct and prevent, as an element of their compliance plan when a fraud occurs (intentional misrepresentation of data for financial gain through services not furnished, bribe, kickback, rebate, misrepresenting servoces and stark (physicians self-referal).
Waste occurs with extravagant expenditure, carelessness and needlessness from deficient practices or decisions like overutilization of services or resources misuse.
Abuse are the poor insuficient methods resulting in unnecessary costs.
The Health Insurance Portability and Accountability Act (HIPAA)
The False Claims Act
The Anti-Kickback Statute
The Health Care Fraud Statute and Criminal Fraud.
The State and Federal Law enforcement include:
- OIG: Office of Inspector General.
- HHS: Department of Health and Human Services.
- FBI: Federal Bureau of Investigation.
- DOJ: Department of Justice.
The Part D regulations include written policies; compliance officer and compliance committee; training and education; effective lines of communication; enforcements of standards through well publicized disciplinary guidelines; corrective action procedures; comprehensive Fraud and Abuse Plans; procedures to voluntarily self-report potential fraud or misconduct.
The Special Investigation Unit, detect problems, make referrals to CMS, follow up and undertake corrective actions.
The FWA prevention laws and legal actions may include significant fines, prision sentence, temporarily or permanently be excluded from the Medicare/Medicaid Program or loose licence (in some States), denial or revocation of being a CMS provider, suspension of payment.
The False Claim Act includes fines up to 3 times the amount of damage.
Anti-Kickback Rebate includes penalties as fines and imprisionment.
Health Insurance Portability and Accountability regulations were set to get payment accuracy and involves CMS staff, fiscal intermediaries and carriers.
