Biomaterial Database

Fraud and abuse compliance programs: their time has come. 1993

P R DeMuro, and J C Roth

Two recent developments in Federal law enforcement should prompt healthcare providers to establish or augment programs to detect and prevent Medicare and Medicaid fraud and abuse. New and controversial Federal sentencing guidelines require judges to impose multi-million dollar fines on companies convicted of certain Federal crimes, and substantial civil monetary penalties may be imposed for violation of the Medicare and Medicaid fraud and abuse laws. One of the ways to avoid these penalties is to establish an effective compliance program designed to prevent criminal conduct before it happens.

UI	MeSH Term	Description	Entries
D008484	Medicaid	Federal program, created by Public Law 89-97, Title XIX, a 1965 amendment to the Social Security Act, administered by the states, that provides health care benefits to indigent and medically indigent persons.	Dental Medicaid Program,Medical Assistance, Title 19,Dental Medicaid Programs,Medicaid Program, Dental,Medicaid Programs, Dental,Program, Dental Medicaid,Programs, Dental Medicaid
D010559	Personnel Management	Planning, organizing, and administering all activities related to personnel.	Client-Staff Ratio,Client Staff Ratio,Client-Staff Ratios,Management, Personnel,Ratio, Client-Staff,Ratios, Client-Staff
D005607	Fraud	Exploitation through misrepresentation of the facts or concealment of the purposes of the exploiter.	Fraud, Health Care,Health Care Fraud,Kickbacks,Drug Counterfeiting,Healthcare Fraud,Counterfeiting, Drug,Fraud, Healthcare,Health Care Frauds,Kickback
D006278	Medicare	Federal program, created by Public Law 89-97, Title XVIII-Health Insurance for the Aged, a 1965 amendment to the Social Security Act, that provides health insurance benefits to persons over the age of 65 and others eligible for Social Security benefits. It consists of two separate but coordinated programs: hospital insurance (MEDICARE PART A) and supplementary medical insurance (MEDICARE PART B). (Hospital Administration Terminology, AHA, 2d ed and A Discursive Dictionary of Health Care, US House of Representatives, 1976)	Health Insurance for Aged and Disabled, Title 18,Insurance, Health, for Aged and Disabled,Health Insurance for Aged, Disabled, Title 18,Health Insurance for Aged, Title 18
D006300	Health Services Misuse	Excessive, under or unnecessary utilization of health services by patients or physicians.	Abuse of Health Services,Misuse of Health Services,Health Services Underuse,Health Services Underutilization,Misuse, Health Services,Underuse, Health Services,Health Services Abuse,Health Services Abuses,Health Services Misuses,Health Services Underuses,Health Services Underutilizations,Misuses, Health Services,Underuses, Health Services,Underutilization, Health Services,Underutilizations, Health Services
D014481	United States	A country in NORTH AMERICA between CANADA and MEXICO.
D017408	Guidelines as Topic	Works about a systematic statement of policy rules or principles. Guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by convening expert panels. For guidelines in the field of health care and clinical medicine, PRACTICE GUIDELINES AS TOPIC is available.	Guidelines as Topics