Stepped-up efforts to ferret out health care fraud have put every provider on the alert. The HHS, DOJ, state Medicaid Fraud Control Units, even the FBI is on the case -- and providers are in the hot seat! in this timely volume, you'll learn about the types of provider activities that fall under federal fraud and abuse prohibitions as defined in the Medicaid statute and Stark legislation. And you'll discover what goes into an effective corporate compliance program. With a growing number of restrictions, it's critical to know how you can and cannot conduct business and structure your relationships -- and what the consequences will be if you don't comply.

Section 1557 is the nondiscrimination provision of the Affordable Care Act (ACA). This brief guide explains Section 1557 in more detail and what your practice needs to do to meet the requirements of this federal law. Includes sample notices of nondiscrimination, as well as taglines translated for the top 15 languages by state.

Government contracting is plagued by nefarious, amateurish, and criminal behavior. By awarding government contracts to corporations as compensation for lavish gifts and personal favors, the United States government fails to serve the public interest effectively and honestly. William Sims Curry identifies and categorizes multiple deficiencies in how government contractors are selected, and proposes how reforms can be instituted.This book is based on extensive research. Curry sifted through two years worth of contractor claims maintained by the Government Accountability Office (GAO) regarding improper behavior of federal government agencies during the contract award process. He identified additional government contracting failures through review of media stories, inspector general reports, court cases, and press releases by government investigatory agencies.Much of this abuse originates from the mandated but ineffective practice of color coding rating proposals and a subjective ratings system. Curry proposes replacing the current practice with a scoring system that weighs contractor selection criteria according to the government's needs. This, along with the other procurement reforms Curry recommends, offers promise for an alternative to the fraud, waste, and incompetence currently rampant in government contracting.

The lack of well-documented, factual information on fraud, waste and corruption in the healthcare sector is an important ally for those who would seek to abuse healthcare systems for their own profit. Our lack of knowledge of the incidence, nature and extent of fraud, waste and corruption in healthcare is a threat to the establishment of effective counter-fraud strategies. It prevents those who finance healthcare provision from understanding in clear and quantifiable terms the need to invest resources into counter-fraud activities. As a consequence, fraud remains a matter of moral hazard and healthcare systems continue to suffer considerable financial damage, as well as all the associated consequences for the quality of care that patients receive. It was for these reasons that the 'European Healthcare Fraud and Corruption Network' (EHFCN) and the 'Dutch Healthcare Authority' (NZa, member of EHFCN) decided to collaborate to publish this book... --

Policymakers and program managers are continually seeking ways to improve accountability in achieving an entity's mission. A key factor in improving accountability in achieving an entity's mission is to implement an effective internal control system. An effective internal control system helps an entity adapt to shifting environments, evolving demands, changing risks, and new priorities. As programs change and entities strive to improve operational processes and implement new technology, management continually evaluates its internal control system so that it is effective and updated when necessary. Section 3512 (c) and (d) of Title 31 of the United States Code (commonly known as the Federal Managers' Financial Integrity Act (FMFIA)) requires the Comptroller General to issue standards for internal control in the federal government.