Week 8 Forum Regulatory Environment: Fraud and Non-Compliance

Regulatory Environment
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Regulatory Environment
Fraud and non-compliance with rules and regulations are the primary problems facing the healthcare management. Over the years, penalties and regulations have changed. It began as early as 1918 with Franklin Martin, who founded the American College of Surgeons (ACS), which was responsible for ensuring that all health care facilities complied with rules of running a facility. He developed a document known as the ‘Minimum Standard for Hospitals’ (Grol & Grimshaw, 2003). Around 1987, there were other regulations under the Stark Laws and the Anti-Kick-Back Act. Today, there are more penalties under the Patient Protection and Affordable Care Act, including the False Claims Act. Regulations extended to ensuring that there is the maintenance of revenues from the patients, and the upgrading and affordability of health care.
Fraudsters are always trying to find a way to violate the penalties and regulations implemented. Accordingly, there is a necessity for a health manager to carry out their responsibilities dutifully. They include making decisions regarding the health care budgeting and community requirements to provide the employees with a vision and direction. The duties also involve rallying the employees to join hands in the fight against fraud. By keeping track of alterations within the facility, it thus becomes easier to identify the presence of fraud (Buchbinder & Shanks, 2011).
The world keeps changing every day, and consequently, fraud still progresses despite the complicated laws. It is hard to affirm that reforms will take place in health care, unless there is a specific compliance program created to bar any illegal activities. The application of the law has only encouraged misperceptions and skepticism within the industry. From a personal point of view, healthcare reforms will promote the development of new legislation, since laws have failed in bringing about chang...