Federal government expands compliance initiatives.
In 1995, the Federal government initiated Operation Restore Trust to increase enforcement of fraud and abuse regulations in Medicare and Medicaid programs. With the success of the original initiative, the government is expanding the project to additional states and program areas. The initial scrutiny of home health agencies, nursing homes, hospice care, and durable medical equipment is being expanded to managed care plans and acute care hospitals with an eye toward DRG creep. To manage this increased enforcement activity, healthcare organizations should institute comprehensive corporate compliance programs. Such programs should provide a framework that delineates responsibilities and provides a systematic means to resolve issues in a timely manner.
Dugan
J K
JK
Coopers and Lybrand, LLP, Philadelphia, PA, USA.
D003953:Diagnosis-Related Groups; D005375:Financial Audit / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D005607:Fraud / Q000331:legislation & jurisprudence / Q000517:prevention & control*; D007344:Insurance Claim Reporting / Q000331:legislation & jurisprudence; D008484:Medicaid / Q000331:legislation & jurisprudence*; D008499:Medical Records / Q000145:classification; D006278:Medicare / Q000331:legislation & jurisprudence*; D017146:Models, Organizational; D016730:Program Development; D014481:United States; D014483:United States Dept. of Health and Human Services