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Healthcare fraud describes to the intentional making of false statements of material facts so as to acquire a healthcare payment for which no entitlement would otherwise exist. The deliberate soliciting Jonathan Marchessault Jersey , paying and acceptance of remuneration to induce referrals for services that get offered by Federal Healthcare Programs also gets considered as healthcare fraud. The intentional billing of services at a higher level than the actual service also gets seen as healthcare fraud. The victims of healthcare frauds include patients, insurance companies, healthcare workers and the government through its medical funding plan. Healthcare abuse describes the actions that are inconsistent with the accepted medical practice and directly or indirectly lead into unneeded expenses to the Medicare program. Examples of healthcare abuse include charging exorbitantly for services and supplies, billing for extra services that were not medically required Brad Hunt Jersey , engaging in deceptive advertising and marketing, and misuse of codes on a claim.
The managers in healthcare institutions are responsible for ensuring that the employees in the organization are aware of the different healthcare frauds and abuses. It is also the task of the healthcare manager to ensure that the workers are not committing the various fraud schemes and abuses.
It is the responsibility of a healthcare manager to ensure that the unit, service, division and the entire institution results in high performance. The manager has to ensure that the institution meets the predefined goals and objectives for service and the organization as a whole. The manager ensures that performance measures set in governance and strategic management William Karlsson Jersey , clinical quality, financial planning, information services, human resources and planning and marketing get accomplished. The five primary phases in the performance management process include the setting objectives David Perron Jersey , measuring the performance, comparing performance with objectives, identifying the cause of deviation and undertaking the suitable corrective action.
The manager is responsible for developing and retaining the employees with excellent performance. The employee performance puts into consideration their practices on issues concerning healthcare fraud and abuse. The approaches used by managers to improve employee performance include providing training and education programs, engaging workers to assess employee satisfaction Luca Sbisa Jersey , providing leadership development programs, and determining employee needs. The healthcare manager is responsible for supervision, monitoring and reviewing employee鈥檚 performance and undertaking management functions in the institution so as to ensure that healthcare fraud and abuse does not take place (Buchbinder & Shanks, 2011). Some of the functions that the manager ensures that the Health Information Management professionals undertake properly include proper documentation of care information by capturing it accurately and timely. The manager should also educate employees as well as ensure that they are aware of the requirements for coding and documentation as defined by governmental Oscar Dansk Jersey , regulatory and professional agencies.