Managed Care Organizations and Integrated Health Care Networks
1 postsRe: Topic 5 DQ 2
This Affordable Care Act helps protect against fraud and the abuse of laws that protect the patients receiving care. There are teams in place that are constantly looking for cases of fraud and returning tons of money back to the Medicaid trust fund. “The Health Care Fraud Prevention and Enforcement Action Team (HEAT), a joint initiative between HHS, OIG, and DOJ, has played a critical role in the fight against health care fraud. A key component of HEAT is the Medicare Fraud Strike Force – an interagency task force teams comprised of OIG and DOJ analysts, investigators, and prosecutors who target emerging or migrating fraud schemes, including fraud by criminals masquerading as health care providers or suppliers.” (CMS, 2016). Having teams like this in place can help protect consumers.
“The Affordable Care Act brings an end to some of the worst insurance industry practices that have kept affordable health coverage out of reach for millions of Americans, especially when they needed it most. Under the health care law, consumers can be confident that their insurance will protect them if they get sick and their families won’t be crushed by medical bills.” (Secretary Sebelius, 2013) The biggest issue for people that need care is that they are afraid to see payment of care they need. Therefore they will not try to get medical care and then become worse over time. This act protects the people and their right to health care, while also protecting them from ridiculous payments.
The Affordable Care Act (ACA) identifies requirements related to provider compliance with fraud, waste, and abuse laws that have been enacted to protect consumers. Research three of these requirements and describe the corresponding measures that your health care organization has initiated, or could initiate, to comply with the ACA. Support your analysis with a minimum of two peer-reviewed articles.
Using 200-300 words APA format with at least two references. Sources must be published within the last 5 years. There should be a mix between research and your reflections. Add critical thinking in the posts along with research. Apply the material in a substantial way.