Kendall M
McDermott, Will and Emery, Boston, MA, USA.
Healthc Financ Manage. 1997 Dec;51(12):64-6.
Hospitals across the United States have began to receive demand letters as part of a joint anti-fraud and abuse effort between the HHS Office of the Inspector General and the Department of Justice regarding laboratory charges unbundling. The goal of this initiative is to recover erroneous payments. U.S. attorneys have been given the opportunity to implement initiatives in their own districts. Violations may be punishable by triple damages, additional $10,000 fines for each false claim filed, and exclusion from Federally funded healthcare programs. The initiative gives hospitals the option of limiting the damages to two times the alleged billing error or single damages if they agree to participate in a self-auditing initiative. Through this initiative, hospitals agree to file an audit plan with the government and disclose the results. In order to limit damage exposure, it is important that hospitals have proof of their good-faith attempts to comply with antifraud and abuse laws by adopting compliance plans and installing software edits in their billing programs.
美国各地的医院已开始收到索款函，这是美国卫生与公众服务部监察长办公室和美国司法部联合开展的一项反欺诈和滥用行为行动的一部分，该行动涉及实验室收费拆分问题。这项举措的目标是追回错误支付的款项。美国各地的联邦检察官已获得在各自辖区内开展相关行动的机会。违规行为可能会受到三倍损害赔偿的处罚，每提交一份虚假索赔还会额外处以1万美元罚款，并被排除在联邦资助的医疗保健项目之外。该举措让医院可以选择，如果同意参与自我审计行动，将损害赔偿限制在所谓计费错误的两倍或单倍损害赔偿范围内。通过这项举措，医院同意向政府提交一份审计计划并披露结果。为了限制损害风险，医院必须有证据证明自己通过采用合规计划并在计费程序中安装软件编辑功能，真诚地努力遵守反欺诈和滥用法律。
