Health Care Fraud Hearing Before a Subcommittee of the Committee On Appropriat

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Health Care Fraud Hearing Before a Subcommittee of the Committee On Appropriat
Health And Human Services United States Congress Senate Committee On Appr
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Establish data collection and retrieval systems to detect fictitious enroll- ment of consumers. (This presupposes implementation of uniform reimburse- ment and billing procedures. ) 4) Require that all enrollment decisions be made directly by consumers or in the case of incapacity, by power of attorney or appointed guardians. Do not per- mit representatives of groups of consumers to make enrollment decisions.
5) To reduce the potential for collusion on reporting of costs or underprovision of ne
...cessary services, ensure that whenever possible, multiple providers, or multiple groups of providers, compete for patient enrollments.
6) Utilize the opportunities for self- regulation by providers. Require that to qual- ify to compete for enrollment by consumers, each group of providers must sub- mit and have approved an anti-fraud, waste and abuse plan. Such a plan must address education, monitoring, detection and disciplining policies. In ad- dition to their other duties, the entities managing the competition among pro- viders should be charged with reviewing, approving and enforcing these plans as well as making referrals for prosecution in egregious instances.


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