Yazi incazelo kanye nezimpawu zokukhokhiswa kwemithi yokukhwabanisa
Uhlelo lwe-Medicare luthembele kakhulu emithonjeni eminingi yokubasiza ekutholeni nasekuvimbeleni ukukhwabanisa kwe-Medicare kubandakanya ochwepheshe embonini yezempilo. Lezi zihlanganisa nalabo abasebenza emahhovisi ezokwelapha - odokotela, abahlengikazi, abasebenzi bedeskithophu, abasebenzi bokukhokhisa kwezokwelapha, nabanye. Ngaphandle kosizo lwethu, labo bantu abanecala lokuziphatha ngobuqili bayaqhubeka behlukana nalo.
Kule minyaka edlule, amaCenter for Medicare kanye neMedicaid Services (CMS) asebenze emizamweni yabo yokwazisa ukukhwabanisa kweMedare, inkinga kazwelonke ebiza uhlelo lwezigidi zamaRandi ngonyaka ngamunye.
Sibutsetelo se-Medicare Fraud
Ukukhwabanisa kweMedare ngokuvamile kubhekisela ekumangalisweni ngamabomu ngokuzenzekelayo nokukhokhisa ngemithi yokuzama ukukhohlisa uhlelo lwe-Medicare ngemali. Noma ubani owatholwa enecala lokukhwabanisa kweMedarela kufanele akhishwe ekuhlanganyeleni ohlelweni lwe-Medicare, ngaphezu kwemali futhi mhlawumbe ejele. Iningi lobugebengu beMedare lwenzeka kulezi zindawo:
- Ukukhokhwa kwe-DME
- Ukukhokhela izinsizakalo zedokotela
- Ukukhokhwa kwezinsizakalo zezikhungo ezinjengamakhaya asezikhungweni, izibhedlela, izifo zokwelapha, njll.
Qaphela ama-Common Medicare Schemes Schera
Kunezinhlelo zokukhwabanisa ezine zeMedare kanye nemikhuba engase ibonwe kwisilungiselelo sehhovisi lezokwelapha.
- Izinsiza Zezokwelapha Azizange Zinikezwe: Indawo ejwayelekile kakhulu yokukhwabanisa kwe-Medicare yikhokhiso yezokwelapha ezihlala njalo (DME). I-DME ibhekisela kunoma imiphi imishini yokwelapha edingekayo esimweni sezokwelapha noma ngokomzimba wesiguli. Ihlanganisa izihlalo zabakhubazekile, imibhede yezibhedlela, nezinye izinto zokusebenza zalowo mvelo. Umhlinzeki uzokhipha imali kuMedare for imishini isiguli esingakaze sithole. Izikolo zokuhamba ziye zithandwa ikakhulukazi kuma-scheme wokukhwabanisa ama-Medicare.
- Izinsizakalo Zikaze Zenziwe Okwenziwe: Kulesi sibonelo, izikhwama zomhlinzeki zokuhlolwa, ukwelashwa noma izinqubo azange zenziwe. Lokhu kungafakwa ohlwini lokuhlolwa isiguli esitholile futhi asiqapheli. Umhlinzeki angaphinde akhohlise amakhodi wokuxilongwa ukuze afake izivivinyo ezingadingekile noma izinsizakalo ezingadingekile.
- Izinkokhelo zokuqeda ukukhokha: Ukungahlehlisi izinga lenkonzo noma inqubo eyenziwe ukuze ukhokhise ngaphezulu noma uthole isilinganiso esiphezulu sokubuyiselwa kubhekwe ukukhishwa kwekhodi. Ukukhishwa kwe-upcoding kwenzeka nangabe isevisi eyenziwe ayihlanganiswa yi-Medicare kodwa izikweletu zomhlinzeki zihlinzeke ngenkonzo ehlanganisiwe endaweni yayo.
- Ukukhishwa Kwezindleko: Ezinye izinkonzo zibhekwa njengezozonke . Ukukhipha ukukhokhisa ukukhokhisa ngezinqubo ezihlukene ngokweqile ezikhokhiswa njengekhokhwa elilodwa. Isibonelo, izikhwama zomhlinzeki zamakhompiyutha amabili wokuhlola okungafani, esikhundleni sokukhokhisa ukuhlolwa kwesinye sezwe esisodwa.
Izikhombisi ze-Medicare zokukhwabanisa
Kunezinkomba ezithile ezivamile ekutholeni ukukhwabanisa kwe-Medicare. Ingabe umkhuba wakho:
- Ingabe ihhovisi lakho lezokwelapha lilahla njalo ama- copayment kanye nama-deductibles kumaGciwane e-Medicare ngaphandle kokuhlola ukuthi bakwazi ukukhokha?
- Ingabe ihhovisi lakho lezokwelapha likhokhisa amazinga aphezulu ezigulini zikaMedare uma kuqhathaniswa nabanye abantu ngezinsizakalo ezifanayo?
- Ingabe ihhovisi lakho lezokwelapha livame ukulahlekelwa amadokhumenti yokwelashwa, njengamanje odokotela noma amanesi?
Yini Okufanele Uyenze Uma Usola Ukukhwabanisa?
Uma usebenza ehhovisi lezokwelapha, ukhona phambili ekutholeni nasekubikeleni umsebenzi wokukhokha osolisayo. Kungumthwalo wakho njengommeleli wembonini yezokunakekelwa kwempilo ukuba aqaphele futhi abike noma yikuphi umsebenzi wokukhwabanisa osolwa.
Uma ungathanda ukubika ukukhwabanisa kweMedare okusolakala ukuthi uyathinteka, xhumana noMnyango WezeMpilo Nemisebenzi Yomuntu noma iHhovisi loMhloli Jikelele ukuze uthole olunye usizo.