Zonke izigulane zinelungelo lokukhetha umboneleli owenza iinkonzo zononophelo zempilo kubo. Oku ngokubhekiselele ekubhekiseni isigulane kwizonyango nezibhedlele. Oogqirha nezibhedlele bahlala bebhekisela kwizigulane kwiingcali, ukunakekelwa kwezempilo ekhaya, amaziko ahlala ixesha elide okanye abanye abaqeqeshi bezempilo ukuze banakekele ngakumbi ngaphandle kobugcisa babo okanye ukukwazi ukuqhubeka nokunyamekela.
Amaxesha amaninzi ugqirha okanye ubudlelwane bebhedlele buphule ilungelo lomguli lokukhetha umnikezeli. Oogqirha bavame ukukhupha ugqirha kumgqirha othile ngokusekelwe kubambiswano okanye olunye ulwalamano. Izibhedlele zihlala zikhupha ukuhanjiswa kubanikezeli okanye abachaphazelekayo. Bonke ababoneleli kufuneka baqaphele ukuba bangabonakali okanye bathathele ukuba isiguli asinakho ukhetho.
Ukuze uqonde ngokupheleleyo izigulane ezifanelekileyo kufuneka ukhethe ababoneleli, bhekisa kule mimithombo emithathu:
- Umthetho ojongene noLwabiwo-mali oLungeleleneyo we-1997: Njengomqathango wokuthatha inxaxheba phantsi kweprogram yonyango lwempilo, izibhedlele zifuneka ukuba zinike uluhlu lwee-arhente zempilo zasekhaya kwizigulane ezikwimeko yesigulane, ziyi-Medicare-ziqinisekisiweyo, zibonisa ukuba ziyacelwa ukuba zibe uludwe kwaye lubonisa ukuba isibhedlele sinomdla kwi-arhente yezempilo yasekhaya.
- IiNkundla: izigqibo zeNkundla zibeke phambili ukuba izigulane zinokulawulwa kwonyango lwazo kuquka ilungelo lokukhetha okanye ukuchonga ngubani onakekelayo, kungakhathaliseki ukuba ngubani ohlawula unyango.
- IiSitatimende Zaseburhulumenteni: Iiprogram ze-Medicare kunye neenkqubo zeMedicaid ziye zazimisela imithetho yemigangatho yokuba izigulane zinelungelo lokukhetha umnikezeli wokunyamekela kwazo kungakhathaliseki ukuba kusetyenziswe unyango.
Ukuchithwa kwelungelo lomguli lokukhetha umboneleli wabo kungakhokelela ekulahlekelweni ilungelo lokuthatha inxaxheba kwiinkqubo ze- Medicare kunye neMedicaid .
Imithetho yobuqhetseba kunye nokusetyenziswa kakubi e-Federal evimbela oogqirha, izibhedlele kunye nabanye ababoneleli ngokuphula umthetho isigulane esinelungelo lokukhetha ngokwenza kubekho mthethweni kubaboneleli ukuba bafumane inkuthazo yokuthunyelwa nokugulisa isiguli ukuba sithole unyango kumboneleli othile. Ababoneleli abahlulekayo ukuyiqonda kwaye bayayihlonela isigulane ilungelo lokukhetha ukuphazamiseka kwemithetho yombuso kunye nombuso kwaye kufuneka babhekane nemiphumo ngokusekelwe kuMthetho wokuKhuseleka.
Umthetho we-Anti-Kickback ubeka amalungiselelo okuchonga kunye nokugweba nabani na onetyala lokwenza izigqibo ezithile zokunakekelwa kwempilo ngokuchithwa ngemali.
Amalungiselelo aninzi kodwa awela phakathi kweendidi ezimbini:
- Nawuphi na umthengi wemali ochaphazela ukuthunyelwa komntu ngamnye nayiphi na inkonzo ehlawulwa phantsi kweProgram yeMedare okanye iMedicaid
- Nawuphi na umthengi wemali okhokelela ekuthengweni kwanoma yintoni into ehlawulwa phantsi kweProgram yeMedare okanye iMedicaid
Imimandla emithathu yomthetho olwa-Anti-Kickback obhekisela kwizigulane kunye nezibhedlele:
- Amalungiselelo okuThunywa kwamanyathelo: kunye nayiphi na intsebenziswano edibeneyo eyenzelwe ukufumana umtsalane wokuthunyelwa kubarhwebi bezilwanyana apho bahlawulwa ngokungaqondakaliyo kunokungabaza. Nayiphi na ugqirha onokufumana inkxaso kwiimali ekudluliselwa kuyo angenza umyalelo okanye enze iinkonzo ezingadingekile ezixabisekileyo kwiinkqubo zeMedare neeMedicaid.
- Izibonelelo Zibhedlele Kwabagqirha: Kwiinkampani ezikhulayo ngokukhawuleza, oogqirha banokuba nzima ukufumana nokugcina. Izibhedlele ezithatha ukutsala amagqirha ngeemfuno ezikhethekileyo zibonisa ukuba ugqirha ubhekisela kuzo zonke izigulane zakhe. Esi sigqibo siza kusekelwe kwimpembelelo yemali kunokuba umgangatho wokunyamekela.
- IiNkonzo zeeBliniki zeeLikliniki: Kwimeko ezithile, i-laboratory yangaphandle ingabonelela ngamagqirha, izibhedlele okanye ezinye iinkonzo ezizodwa ngaphandle kobunzima babo okanye izilwanyana. Ingabonwa njengenzuzo ngokutshintshiselwa ukuhanjiswa kwibhubhoratri.