Zonke iziguli zinelungelo lokukhetha umhlinzeki obanika izinsizakalo zokunakekelwa kwezempilo kubo. Lokhu kuvame ukubhekisela ekudlulisweni kwesiguli kusuka odokotela nezibhedlela. Odokotela nezibhedlela bavame ukuthumela iziguli kubachwepheshe, ukunakekelwa kwezempilo ekhaya, izikhungo zesikhathi eside noma ezinye izisebenzi zokunakekelwa kwezempilo ukuze zithole ukunakekelwa okwengeziwe ngaphandle kobuchwepheshe babo noma ikhono lokunikeza ukuqhubeka kokunakekelwa.
Izikhathi eziningi udokotela noma ubudlelwane esibhedlela baphula ilungelo lomguli lokukhetha umhlinzeki ozikhethelayo. Odokotela bavame ukukhipha ukudluliselwa kudokotela othize ngokusekelwe kubambiswano noma ubuhlobo obunye. Izibhedlela zivame ukukhipha ukuhanjiswa kwabahlinzeki abangabanikazi noma abathintekayo. Bonke abahlinzeki kumele baqaphele ukuthi bangacacisi noma babhale ukuthi isiguli asinakho ukukhetha.
Ukuze uqonde ngokugcwele iziguli ezifanele ukuthi zikhethe abahlinzeki, bhekani kulezi zindlela ezintathu:
- Umthetho Wezezimali Olinganiselayo ka-1997: Njengesimo sokubamba iqhaza ngaphansi kohlelo lokunakekelwa kwezempilo, izibhedlela kudingeka zinikeze uhlu lwezokwelapha zezempilo emakhaya ezigulini ezisezindaweni zesiguli, yi-Medicare-eziqinisekisiwe, zibonisa ukuthi ziceliwe ukuba zibe uhlu futhi ubonisa ukuthi isibhedlela sinesithakazelo sezimali ejensi lezempilo ekhaya.
- Izinkantolo: Izinqumo zenkantolo zibeke phambili ukuthi iziguli zilawule ukwelashwa kwazo kuhlanganise nelungelo lokukhetha noma ukunquma ukuthi ngubani onakekelayo, kungakhathaliseki ukuthi ubani okhokhela ukwelashwa.
- Izitatimende Zase-Federal: Amasevisi Wezinhlelo ze-Medicare ne-Medicaid azikhethele izimiso zombuso ukuthi iziguli zinelungelo lokukhetha umhlinzeki wokunakekelwa kwazo kungakhathaliseki ukuthi zikhona yini ukwelashwa.
Ukuphulwa kwesiguli ilungelo lokukhetha umhlinzeki wokunakekelwa kwabo kungaholela ekulahlekelweni ilungelo lokubamba iqhaza kwizinhlelo zeMedare and Medicaid .
Imithetho yenkolo yokukhwabanisa nokuhlukunyezwa ivimbela odokotela, izibhedlela kanye nabanye abahlinzeki ngokuphula ilungelo lesiguli lokuzikhethela ngokwenza ngokungemthetho kwabahlinzeki ukuthi bathole ukugqugquzela ukuthunyelwa nokugulisa isiguli ukuze bathole ukwelashwa kumhlinzeki othile. Abanikezeli abahluleka ukuqaphela futhi bahloniphe ilungelo lomguli lokukhetha ingozi yokuphula imithetho yesifundazwe neyezwe futhi kufanele babhekane nemiphumela esekelwe eMthethweni Wokuphikisana Nomthetho.
Umthetho we-Anti-Kickback ubeka izinhlinzeko zokukhomba nokwelulekisa umuntu onecala lokwenza izinqumo ezithile zokunakekelwa kwezempilo ngokushintshanisa imali.
Izinhlinzeko zibanzi kodwa ziwela ngaphansi kwezigaba ezimbili:
- Noma yikuphi ukuthengwa kwemali okuthonya ukudluliselwa komuntu kunoma iyiphi insizakalo ekhokhwa ngaphansi kohlelo lwe-Medicare noma lwe-Medicaid
- Noma yikuphi ukuthengiswa kwemali okuholela ekuthengweni kwanoma iyiphi into ekhokhwa ngaphansi kohlelo lwe-Medicare noma lwe-Medicaid
Izindawo ezintathu zomthetho we-Anti-Kickback ezibhekisela odokotela nezibhedlela:
- Amalungiselelo Okuhlanganisana: Noma yikuphi ukuhlanganiswa okuhlangene okwakhiwe ukuze uthole ukuthunyelwa kokudluliselwa kwabalimi abadokotela lapho behlawuliswa ngokungaqondile kungabaza. Noma yimuphi udokotela ozuzwa ngokwezimali ngokudluliselwa angenza umyalelo noma enze izinsizakalo ezingadingekile ezibiza izindleko ze-Medicare ne-Medicaid.
- Izibonelelo Zezibhedlela Kuzokwelapha: Embonini ekhula ngokushesha, odokotela kungaba nzima ukuthola nokugcina. Izibhedlela ezithinta ukuheha odokotela ngezikhuthazo ezikhethekile zibonisa ukuthi udokotela ubhekisela kuzo zonke iziguli zakhe. Lesi sinqumo sizobe sisekelwe emoyeni wezezimali kunezinga lokunakekelwa.
- Amasevisi Lab Lab Labliniki: Kwezinye izimo, i-laboratory yangaphandle inganikeza odokotela, izibhedlela noma ezinye izinsizakalo ezikhethekile ngaphandle komsebenzi wabo noma okulindelekile. Kungabhekwa njengenzuzo ngokushintshaniswa kokudluliselwa ku-laboratory.