read post and reply substantially and ask an outstanding question

1. State a hypothesis (key statement).

Response- In the act of False Claims Act, the personnel within the organization itself has other parties involved with fraud payments by federal funding, which affects operations to their overall financial revenue towards future investments (Research/Development to treatment, Infrastructure to Expand Services, and even Financial Debts during pandemics/epidemics).

2. Identify the specific law and its statute. -Criminal Health Care Fraud Statute (18 U.S.C Section 1347)

Response- This specific law in the U.S. Constitution is focused on the delivery and verification of medical purchases, even controlling to ensure the healthcare programs are not causing fraud that will potentially harm the organization as a whole when distributing care.

3. From the readings and independent research, find one (1) specific CURRENT real-life legal case that can serve as an example of an HCO's breach of the False Claims Act, a federal statute. (not sure if you want them to find adjudicated cases?)

Response- Based on providing transparency of products, services, and even promotional campaigns within a healthcare organization is the key to developing the proper trust within the 'target market' their aiming for. With this in mind, even healthcare has advanced to a degree where telehealth and virtual meetings in the comfort of a patient's home, which this has opened the doorway for services to be installed in their homes for self-sufficiency. One particular case dealt with Signature Home now which is a modern home healthcare agency, that focused on promoting high services to boost quality of life but has met with fraudulent cases when interfering against those receiving charges on Medicare from healthcare services. According to Bailey, they stated, "The beneficiaries were either not homebound, did not require skilled care, did not have valid or appropriate care plans, or did not have the necessary in-person visits to be appropriately certified to receive the home healthcare services" (Bailey, 2022). As a result of this, displaying various treatment plans, care plans, and even the appropriate consensus, can play a big role in patient development when healthcare services, since ensuring satisfaction is considered a top priority, with reasonable timing intervals of charges must be discussed thoroughly between both parties to reduce miscommunication!

4. Note the violation. Does this violation relate to all payment programs (Medicare or Medicaid or Military or Railroad Workers or Indian Health Service or Ryan White) or just about specific ones?

Response-This specific Criminal Health Care Fraud Statute, is more related to the aspect of 'Anti-Kickback'. since Federal Healthcare Programs do play a role, in the growing world of healthcare through proper finances issued by the U.S or organizations to improve the quality of life for patient's being treated. Especially towards the development of establishing the very foundations of a healthcare organization, when it comes to verified purchases for the future of healthcare itself, and in which tax fraud, with even providing equal opportunities to reduce potential frauds within transactions itself when improving healthcare services.

5. Discuss what would help healthcare organizations equip themselves to ensure compliance and minimize exposure risks like the one that you reported.

Response-To provide the best occupancy, and even reduce the potential risk of mitigation for fraud exposure, with the results of maintaining a stable source of proper distribution amongst purchases of healthcare services. Additionally, providing the regulatory changes possible to policies regarding standards will always provide the healthcare organization the best adaptability to various tax frauds within purchases and sabotages by personnel. According to PowerDMS, they stated, "Of course, it's impossible for any healthcare organization - any organization, really - to eliminate risks. But effective policy management is one of the best risk mitigation strategies in healthcare you can have" (PowerDMS, 2020). As this mentions, even if it may be impossible to prevent the risk, and, providing the proper standards of healthcare methods with the right operations being used to attend to the needs of patients through the use of transparency (Treatment Plans, Surgeries, etc). Additionally, the many uses of managing verified information can lead to the prevention of risk by personnel creating effective operations, to create a safe environment when treating patients to reduce risk for penalties affecting overall investments.

To structure PART B (Anti-Kickback Statute or Stark Law) of your post:

1. State a hypothesis (key statement).

Response- Within the Anti-Kickback Statute, violations are centered primarily around bribes or even making 'false referrals' that could affect the transparency, operations, and even reputation towards healthcare services distributed to patient's needs.

2. Identify the specific law and its statute.(False Claims Act, 31 U.S.C Section 3729)

Response- This specific law is responsible for reducing fraudulent payments and even reducing false statements from businesses, and this even includes third parties being charged under fraud conduct of false payments.

3. From the readings and independent research, find one (1) specific CURRENT real-life legal case that can serve as an example of an HCO's or health professional's breach of the Anti-Kickback Statute or Stark Law, both federal statutes.

Response-Based on current institutes of healthcare the use of fraud, and even whistleblowers can become detrimental to the overall total revenue of a healthcare organization towards potential investments for future healthcare treatments. Especially in recent cases in U.S. healthcare, the Department of Justice, discovered multiple services ranging from pharmacies to even long-term facilities cause federal losses due to fraud, and even now the addition of Medicaid helps reduce the fraud payments. According to Healthcare Finance News, they stated, "For instance, the DOJ filed a complaint in intervention in a whistleblower lawsuit against Rite Aid Corporation and various subsidiaries alleging that Rite Aid filled unlawful prescriptions for controlled substances in violation of the False Claims Act and the Controlled Substances Act" (Healthcare Finance News, n.d.). Based on the False Claims Act being affected by transparency and potential operations being compromised, and in a general sense that may be the case for some, but the overall goal is to prevent these frauds from happening including 'false referrals'. The False Claims Act has submitted multiple claims, regarding unlicensed and even those with false referrals, these claims help reduce the amount of these frauds to provide better transparency within healthcare organizations to maintain official referrals for each patient in their treatment towards effective delivery!

4.Note the violation. Does this violation relate to all payment programs and all health providers or just specific ones?

Response- This specific healthcare statute is focused more on the aspect of'Stark Laws', since this is related to physicians it focuses on the aspects within pharmacies when patients are referred to getting their medication, labs when having full transparency towards lab results given to patients, and even care providers providing the necessary care for patients to achieve their results. In addition, establishing the foundation of focusing on pure investments in current services to boost demographics, and even achieve the necessary support for the patient's endeavors with full support of personnel to a brighter healthcare future!

5. Discuss what would help HCOs equip themselves to ensure compliance and minimize exposure risks like the one you reported.

Response- To prevent future frauds within the healthcare system, to provide regulations in which a method will reduce conflicts amongst personnel since working towards a common goal of transparency and treating patients effectively is the goal! Additionally, developing regulations that uphold the values of using false claims to ensure future cases won't appear, and that Medicare and Medicaid alike will bring the best outcome needed for financial support for patients receiving the care needed. Furthermore, billing must be full transparency from treatment plans, equipment used, and even treatments given to the patients to reduce the amount of confusion between both parties. Overall, fraud and impersonation of healthcare providers prove to be detrimental to local and federal organizations, but with the understanding of regulations and even flexibility with claims, will provide the best outcome for patient's well-being and healthcare organizations in proper investments to improve healthcare as a whole to treat new demographics!