I-Ofisi yoMhloli-Jikelele (i-OIG) yenzele kwaye yakhupha izilumkiso ezikhethekileyo zobuqhetseba kuluntu loncedo lwezempilo. Ezi zilumkiso zenzelwe ukupapasha iintlobo zobuqhetseba kwilizwe jikelele. Kwakhona yindlela yokubonelela kunye nokwazisa malunga nezenzo zobuqhetseba ngaphakathi kwoshishini kunye nokuphulwa kweedilesi ezithile kwi- Medicare neMedicaid Anti-Kickback Law.
I-Medicare neMedicaid Anti-Kickback Law
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
Izigwebo zokuphula umthetho we-Anti-Kickback zingaba nzima. Umthetho olwaphulo-mthetho olwa noKhuselo ngowona mthetho onokubangela ukuhlawulwa kwe-$ 25,000 ngokuphulaphula kunye / okanye ukuvalelwa entolongweni ukuya kwiminyaka emihlanu. Ukongeza kwiintlawulo kunye nokuvalelwa entolongweni, ababoneleli banakho ukukhutshwa ngaphandle kokuthatha inxaxheba kwiNkqubo yoLondolozo lwezeMpilo kaRhulumente. Xa umboneleli engabandakanywa ekuthatheni inxaxheba kwiNkqubo yoLondolozo lwezeMpilo kaRhulumente, umniki-mali akasakwazi ukufumana iintlawulo zeenkonzo ezenziwe okanye izinto ezibonelelwe kwizigulane.
Oku kubandakanya iinkonzo ezenziwe okanye izinto ezinikezelwe kwisikhokelo okanye umyalelo we-excluded provider.
Izaziso eziKhethekileyo zobuqhetseba
I-OIG ithethe indawo ezinhlanu ezingabonisa ukuphulwa komthetho wokulwa nokukhawuleka. Ayikho into ejoliswe kuyo nayiphi na injongo ngaphandle kokubona umsebenzi onokukhwabanisa.
- 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.
- Ukukhutshwa kweeCopayments okanye i-Deductibles: Ngokukhawuleza ukurhoxisa iipayili okanye ukuxhomekeka kwiigulane ze- Medicare ngaphandle kokuqulunqa ubunzima bezemali kwiziphumo ekusebenziseni ngokubanzi iinkonzo ezihlawulwa yi-Medicare. Umboneleli unokubangela izigulana zibe nezinto okanye iinkonzo ezingekho mfuneko. Izigulane zikulungele ukuthobela ngenxa yokuba izinto kunye neenkonzo zikhululekile.
- 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.
- Ukuthengiswa kweMithi yokuLawulwa kweMithi: Oogqirha okanye oomachiza abamkela izipho okanye iintlawulo ngokuchitshiyelwa ukumisela izigulane zabo izidakamizwa ezithile zithatha ingozi ngokunyamekela kwabo. Iintlawulo ezinikwe izigulane ngokuguqula imithi evela kwimveliso enye kuya kwindlela yokuziphatha eyingozi.
- 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.
Ukunika ulwazi
Ukuncedisa ukunciphisa ubuqhetseba, i-OIG icela ukuba uqhagamshelane neSebe lezeMpilo kunye neNkonzo zoLuntu okanye i-Ofisi yoMhloli-Jikelele ngeenkcukacha onokuyenza malunga nabani na ababandakanyekayo kwiindlela zokunakekelwa kwempilo ezingekho mthethweni.
Imithombo:
Brown, uJuni Gibbs. ISaziso soMhloli jikelele. I-Ofisi yoMhloli-Jikelele. ISebe lezeMpilo laseMelika kunye neeNkonzo zoLuntu. Umhla kaDisemba 2, 1994, www.oig.hhs.gov.