Yazi inkcazo kunye nemimiselo yecala lokuthengisa inkohliso
Iprogram ye-Medicare incike kakhulu kwimithombo emininzi yokubanceda ekufumaneni nasekukhuselweni kobuqhetseba be-Medicare kubandakanya abaqeqeshi bezoshishino. Ezi zibandakanya abo basebenza kwiiofisi zonyango - oogqirha, abahlengikazi, abasebenzi beedesksi phambi, abasebenzi bezentlawulo zonyango kunye nabanye. Ngaphandle koluncedo lwethu, abo bantu abanetyala lokuziphatha ngobuqhetseba bayaqhubeka behamba nabo.
Kule minyaka, amaziko e-Medicare kunye neeNkonzo zeMedicaid (CMS) iye yaqhuba kwimigudu yawo yokuzisa ulwazi lwe-Medicare lobuqhetseba, ingxaki yesizwe ebiza iiprogram zezigidi zeedola ngonyaka.
Ubume benkcazo ye-Medicare Fraud
I-Medicare ubuqhetseba ngokuqhelekileyo ibhekisela kwizibango zonyango ngokuzithandela nangokuzibonela ngenzame yokukhwabanisa inkqubo ye-Medicare ngemali. Nabani na ofunyenwe unetyala lobuqhetseba beMedare uyaxhomekeka ekubandakeni ukuthatha inxaxheba kwiprogram ye-Medicare, ngaphezu kokuhlawulwa kunye nokuhlawulwa entolongweni. Uninzi lobuqhetseba lweMedare luvela kule mimandla:
- Ukuhlawula i-DME
- Ukuhlawula ngamatyala iinkonzo
- Ukuhlawula iintlawulo kwiinkonzo zesikhungo ezinjengamakhaya asebekhulile, izibhedlele, i-hospice, njl.
Qaphela iiShedyuli eziNkohliso zoLuntu
Kukho amaqhinga amane okukhwabanisa amayeza kunye nezenzo ezingabonwa kwimeko yeofisi yezobugcisa.
- Izixhobo Zonyango Akuzange Zinikezelwe: Indawo eqhelekileyo yobuqhetseba be-Medicare yintlawulo yeZiko loLwazi oluPhezulu (DME). I-DME ibhekisela nasiphi na izixhobo zonyango eziyimfuneko kwisigulane okanye kwisimo somzimba. Iquka izihlalo zamasondo, izibhedlele zesibhedlele kunye nezinye izixhobo zolu hlobo. Umboneleli uya kuhlawula i-Medicare kwisixhobo esiye safumana isiguli. Abaqhubi bee-Mobility baye bathandwa kakhulu kwiinkqubo zobuqhetseba ze-Medicare.
- IiNkonzo azizange zenzeke: Kule meko, umniki-mboleko weenkonzo kumvavanyo, unyango okanye iinkqubo azange zenziwe. Oku kungongezwa kwoluhlu lweemvavanyo isiguli esifumene kwaye asizange siphawule. Umboneleli angaphinda akhohlise iikhowudi zokuxilonga ukuze afake iimvavanyo okanye iinkonzo ezingadingekile.
- Iintlawulo zokuhlawula iikhowudi: Ukungabonakali kwinqanaba lenkonzo okanye inkqubo eyenziweyo ukwenzela ukuhlawula ngaphezulu okanye ukufumana isantya sokubuyisela phezulu kuthathwa njenge-coding. Ukugqithisa kwakhona kuyenzeka xa inkonzo eyenziweyo ingagqitywa yi-Medicare kodwa iindleko zeenkonzo ezikhuselekileyo kwiindawo zayo.
- Ukuhlawulwa kweeNkokhelo: Ezinye iinkonzo zithathwa njengento ebandakanya bonke. Ukuqhawula ukuhlawulela i-billing kwiinkqubo ngokwahlukileyo ezihlawulwa ngokuqhelekileyo njengentlawulo enye. Umzekelo, umniki-mboleko wonikezelo lwezilwanyana ezimbini zokungcebeleka, ngaphandle kokuhlawula i-one-quarryal screening mammogram.
IiMpawu zoBuqhetseba
Kukho izibonakaliso ezithile eziqhelekileyo ekufumaneni ubuqhetseba beMedare. Ngaba uyasebenza:
- Ingaba i-ofisi yakho yezobugqirha ihlala ikhupha iikhoyayili kunye neengxowankulu kwiigulane ze-Medicare ngaphandle kokujonga ukuba zikwazi ukuhlawula?
- Ingaba iofisi yakho yezokwelapha ihlawulisa amazinga aphezulu kwiigulane zikaMedarele xa kuthelekiswa nabanye abantu kwiinkonzo ezifanayo?
- Ingaba iofisi yakho yezobugqirha isoloko ilahleka amaxwebhu enyango, njengogqirha okanye amanesi?
Yintoni Oyenzayo Ukuba Usola Ukukhwabanisa?
Ukuba usebenza kwiofisi yezobugcisa, ungowomgca wokuqala ekufumaneni nasekunikeleni umsebenzi wokubakhokisa osolisayo. Kuxanduva lwakho njengommeli wezezimboni zezokwelapha ukuba wazi kwaye akhankanye umsebenzi owenzela ukukhwabanisa.
Ukuba ungathanda ukubika ukukhwabanisa kweMicroare ekhankanyweyo, qhagamshelana neSebe lezeMpilo kunye neNkonzo zoLuntu okanye i-Ofisi yoMhloli-Jikelele ukuze uncediswe.