Goldberg Michael K
Goldberg & Frankenstein, LLC, 222 South Riverside Plaza, Suite 810, Chicago, IL 60606, USA.
J Med Pract Manage. 2002 Jan-Feb;17(4):206-9.
Health care fraud has a significant financial effect on the operations of the American health care system. Governments and insurers are intent on quashing such fraud and have instituted massive efforts to indict and punish offenders as well as recover major monetary awards. This article provides examples of fraudulent practices and details the definitions of fraud and abuse. In addition, it characterizes the concept of qui tam that allows whistleblowers to share in any financial awards. Finally, it highlights the importance of proper coding as a means of reducing the suspicion of fraud or abuse.
医疗保健欺诈行为对美国医疗保健系统的运营产生了重大财务影响。政府和保险公司一心想要杜绝此类欺诈行为，并已展开大规模行动，以起诉和惩处违法者，同时追回巨额金钱赔偿。本文列举了欺诈行为的实例，并详细阐述了欺诈和滥用的定义。此外，还介绍了qui tam（qui tam诉讼）的概念，即允许举报人分享任何金钱赔偿。最后，强调了正确编码作为减少欺诈或滥用嫌疑手段的重要性。
