Say what you will about Obamacare, but the President has made eliminating fraud, waste, and abuse in healthcare a top priority. The Attorney General and Health and Human Services (HHS) Secretary recently released a report on health care fraud prevention and enforcement efforts in Fiscal Year (FY) 2011.1 Nearly $4.1 billion was recovered, the highest ever reported. The Health Care Fraud Prevention & Enforcement Action Team (HEAT) works to prevent fraud, waste, and abuse in the Medicare and Medicaid programs. Their efforts and other approaches are being expanded using tools authorized by the Affordable Care Act.
Most individuals with chronic conditions would much prefer to remain at home in familiar surroundings than be relocated to a nursing care facility. Yet, the largest expenditures under state Medicaid programs involve providing institutional care for the chronic, long-term care population.
Recently, I attended the WOCN Mid-Atlantic Regional conference. There, a nurse attorney discussed strategies to limit liability and improve patient care. The Maryland Patient Safety Law requires that hospitals report all Level I events to the state Office of Health Care Quality (OHCQ). The penalties for failing to meet these requirements can include revocation of the hospital’s license or a fine of $500 per day.
