Write a workplace brief (8-10 double-spaced pages) of evidence-based recommendations to identify and address upcoding, an incorrect health care billing practice. Include a description of the major categories of health care fraud and abuse and the laws designed to address them.
Introduction
Health care leaders must be familiar with laws, regulations, and the associated organizational policies and procedures that support compliance. Fraud and abuse are just one example of an important compliance area in health care administration. This is a complex legal subject; however, many helpful government resources, are available to enhance understanding of laws, regulations, and steps to take when suspected or actual incidents occur. Other important legal considerations within health care fraud and abuse include the:
Federal False Claims Act.
Anti-Kickback Statute.
Physician Self-Referral Law.
Criminal Health Care Fraud Statute.
Exclusion Statute.
Civil Monetary Penalties Law.
Some of these involve related or overlapping areas.
This point in your health care administration career is an ideal time to deepen your knowledge of and skills in these fraud and abuse areas. You may wish to develop a short list of legal topics to assist in the ongoing future monitoring of workplace activities. It is important to include the associated authoritative governmental websites in your topic list.
In this assessment, you will continue your teamwork for Vila Health’s Chief Compliance Officer. This time, you have been tasked with constructing a workplace brief for recommendations on the identification of and interventions to address incorrect healthcare billing practices. In this case, upcoding is the incorrect billing practice that is the focus of the Chief Compliance Officer. Your workplace brief will be used to influence future policy and procedure content for billing practices, including the incorrect practice of upcoding.
