Usizo Ukuvimbela Ukukhwabanisa Kwemithi

Ihhovisi le-Inspector General (OIG) lenzelwe futhi lanikeza izaziso ezikhethekile zokukhwabanisa emphakathini wokuhlinzeka ngempilo. Lezi zixwayiso zazihloswe ukusabalalisa izindlela zikazwelonke zokukhwabanisa emphakathini jikelele. Futhi kuyindlela yokunikeza ukuqonda nokuqaphela imikhuba yokukhwabanisa ngaphakathi kwemboni kanye nokwephula ikheli okuqondene noMthetho we- Medicare ne-Medicaid Anti-Kickback Law.

I-Medicare ne-Medicaid Anti-Kickback Law

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

Izijeziso zokuphula umthetho we-Anti-Kickback zingaba nzima. Ukuphula umthetho we-Anti-Kickback kuwubugebengu obuhambisana nombuso ongabangela izinkokhelo ezifinyelela ku-$ 25,000 ngokuphulwa noma / noma ukuboshwa iminyaka emihlanu. Ngaphezu kokuhlawuliswa nokuboshwa, abahlinzeki bangasuswa ngaphandle kokubamba iqhaza ohlelweni lwezempilo lwe-Federal Healthcare Program. Uma umhlinzeki engekho ekubambeni ohlelweni lwe-Federal Healthcare Program, umhlinzeki akakwazi ukuthola izinkokhelo kunoma yiziphi izinsizakalo ezenziwe noma izinto ezinikezwe iziguli.

Lokhu kufaka phakathi izinsizakalo ezenzelwe noma izinto ezihlinzekwe esiqondisweni noma ngokubhaliswa komhlinzeki ongaphandle.

Izaziso Ezikhethekile Zokukhohlisa

I-OIG ibike izindawo ezinhlanu ezingase zibonise ukwephulwa komthetho wokulwa nokukhahlela. Awuhlosiwe nakanjani nganoma iyiphi enye injongo ngaphandle kokubona umsebenzi onokukhwabanisa.

• 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.
• Ukukhokha ama-Copayments noma ama-Deductibles: Ukukhishwa kwama-copayments noma ama- deductibles njalo kwizigulane ze-Medicare ngaphandle kokuqeda ukubhekana nezinkinga zezezimali ekusebenziseni ngokweqile kwamasevisi akhokhelwa yi-Medicare. Umhlinzeki angenza iziguli zibe izinto noma izinsizakalo ezingenasidingo. Iziguli zizimisele ukuthobela ngoba nje izinto nezinsizakalo zikhululekile.
• 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.
• Ukudayiswa Kwemithi Yezidakamizwa: Odokotela noma abakwa-pharmacy abamukela izipho noma izinkokhelo ngokushintshana kweziguli zabo ezinezidakamizwa ezithile zemithi bathatha izingozi ngokunakekelwa kwazo. Izinkokhelo ezinikezwe iziguli zokushintsha imithi evela komunye umkhiqizo kuya komunye futhi ziyisibonakaliso sokuziphatha okuyingozi.

• 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.

Ukubika Ulwazi

Ukuze usize ukunciphisa ukukhwabanisa, i-OIG icela ukuthi uxhumane noMnyango WezeMpilo NezeNsizakalo Zabantu noma iHhovisi loMhloli Jikelele ngolwazi ongase ube nalo mayelana nanoma ubani ohlanganyela emisebenzini yokunakekelwa kwempilo engekho emthethweni.

_Imithombo:

_{Brown, June Gibbs. Isaziso Esijwayelekile Sophiko. Ihhovisi leMhloli Jikelele. UMnyango WezeMpilo waseMelika kanye Nezinsizakalo Zabantu. Usuku langoDisemba 2, 1994, www.oig.hhs.gov.}