Carpenter Law Firm PC, Scottsdale, AZ, USA.
J Am Pharm Assoc (2003). 2011 Mar-Apr;51(2):e3-16. doi: 10.1331/JAPhA.2011.10168.
To describe the new Medicare and Medicaid waste, fraud, and abuse provisions of the Affordable Care Act (H. R. 3590) and Health Care and Education Affordability Reconciliation Act of 2010 (H. R. 4872), the preexisting law modified by H. R. 3590 and H. R. 4872, and applicable existing and proposed regulations.
Waste, fraud, and abuse are substantial threats to the efficiency of the health care system. To combat these activities, the Department of Health and Human Services and Centers for Medicare & Medicaid Services promulgate and enforce guidelines governing the proper assessment and billing for Medicare and Medicaid services. These guidelines have a number of provisions that can catch even well-intentioned providers off guard, resulting in substantial fines. H. R. 3590 and H. R. 4872 augment preexisting waste, fraud, and abuse laws and regulations. This article reviews the new waste, fraud, and abuse laws and regulations to apprise pharmacists of the substantial changes affecting their practice.
H. R. 3590 and H. R. 4872 modify screening requirements for providers; modify liability and penalties for the antikickback statute, federal False Claims Act, remuneration, and Stark Law; and create or extend auditing and management programs. Properly navigating these changes will be important in keeping pharmacies in compliance.
描述平价医疗法案（H.R.3590）和 2010 年医疗保健和教育负担能力协调法案（H.R.4872）中医疗保险和医疗补助的新的浪费、欺诈和滥用条款，以及 H.R.3590 和 H.R.4872 修改后的原有法律，以及适用的现有和拟议法规。
浪费、欺诈和滥用是医疗保健系统效率的重大威胁。为了打击这些活动，美国卫生与公众服务部和医疗保险和医疗补助服务中心颁布并执行了管理医疗保险和医疗补助服务的正确评估和计费的准则。这些准则有一些规定，即使是善意的提供者也可能措手不及，导致巨额罚款。H.R.3590 和 H.R.4872 增加了原有浪费、欺诈和滥用的法律和法规。本文回顾了新的浪费、欺诈和滥用法律和法规，以使药剂师了解对其实践产生重大影响的变化。
H.R.3590 和 H.R.4872 修改了提供者的筛选要求；修改了反回扣法规、联邦虚假索赔法、报酬和斯塔克法的责任和处罚；并创建或扩大了审计和管理计划。正确应对这些变化对于保持药房合规性非常重要。
