Assignment:
Introduction
Introduction To Updating and Enforcing Compliance Programs
A health care organizations best defense against governmental and regulatory penalties is the careful carrying out of internal audits. Internal audits are also the best preparation for inevitable external audits, and provide the very best information for appeals from such external audits, for which providers have multiple levels of rights.
Objectives
To successfully complete this learning unit, you will be expected to:
- Consider the various types of audits.
- Learn the best uses of each type.
- Identify concerns caused by specific types of audits in particular circumstances.
- List the elements of an internal audit.
- Understand the benefits of internal auditing.
- Explore the reasons for government and private agency audits.
- Learn which agencies audit health care facilities.
- Describe how the HIM department should handle receipt of subpoenas.
- List the levels of responsibilities assessed by auditors.
- List the types of appeals available to health care facilities.
Discussion
Answer the following questions:
1. Choose a policy or regulation to be audited (internally) in your facility and write a detailed description of what you want your audit to review; determine if the audit will be concurrent or retrospective; decide if the audit will be sampling or comprehensive; and identify members of the audit team.
2. Go online to any two healthcare third-party websites and compare and contrast their anti-fraud effort
Case Study
"On Monday March 26, 2007 in Los Angeles, CA Haydee,Parungao was sentenced to 57 months in prison and ordered to pay $3.1 million in restitution for her role in a health care fraud scheme. Parungao also structured $613, 710 in cash transactions to avoid the IRS reporting requirements. The registered nurse worked as an independent contractor for several home health agencies and she claimed to provide in home nursing services for Medicare patients. Between January 2001 and February 2003, Parungao claimed she made more than 18,000 home health visits.
Parungao purported to work every single day during this time period, including every weekend, holiday, averaging 20 visits per day. Parungao operated in cash, and did not have a bank account or any property in her name. She made so many referrals to her home health agencies that she received more than $10,000 in a single pay period. Payments totaling more than$10,00 were systematically divided into two or more checks, with each check written for less than $10,000. Parungao did that to avoid triggering cash transaction reports that would go to the IRS".
Attachment:- Corporate Compliance and Legal Issues.rar