Introduction
With the government offering health care programs for the population, the number of frauds in the field increases, as well. False Claims Act violation in health care is becoming a serious concern for medical workers, insurers, and governors. Billions of dollars paid, the government is forced to pledge money to cover the false records and cases if the latter is not reported timely. In this work, thus, the development of the False Claim Act (FCA), its purposes, radiology director duties, and several steps to prevent the FCA fraud from happening will be considered.
The FCA Development and the Law Purposes
The FCA, now a widely known law for preventing the government from needless spending, was established in 1863. Correll et al. (2017) state that the law set both criminal and civil penalties for anyone who deliberately submitted false claims to the government. According to the first edition of the law, the defendant was obliged to pay 2000$ per violation and double payment for the damage sustained by the government if a civil penalty was detected (Correll et al., 2017). If a criminal penalty took place, the punishment was stricter – the defendant might be imprisoned up for five years. The FCA law encouraged individuals, known now as relators, to bring the information about the possible fraud to the government’s attention and to prosecute the cases in support of the government (Correll et al., 2017). Thus, the punishment for the FCA violation was rather strict, obliging the violators either pay a significant amount of money or be imprisoned.
Currently, three elements are to be proved to accuse someone of fraud. According to Correll et al. (2017), the government should present evidence that a defendant provided a claim for the government; the claim is false, and the defendant submitted the claim knowing it was false. It is also stated that the cases must be brought to the government’s attention within the six years of the alleged violation, or three years of when the government should have known about the incident.
The Radiology Director Duties in HCA Healthcare Corporation
HCA Healthcare Corporation, founded in 1968, is now an American provider of medical facilities across the US. Radiology directors in HCA Healthcare have their duties that undoubtedly demands total commitment. Besides, being in charge of the department requires a wide range of responsibilities. Coordination and direction work of the radiology and diagnostic department in the medical facility, developing policies and working plans regarding operations, supervising, and purchasing radiology supplies are among them. Fluoroscopes, X-ray machine, or CT scanners might fail when most needed. Furthermore, reviewing work schedules and assigning duties to health workers are to be implemented. To guarantee the safety of staff and patients, the director realizes safety measures and monitors the radiation. They must also demonstrate new equipment, techniques, and procedures to personnel to ensure providing high-quality patient care. Moreover, the radiology director might be in charge of managing the department budget.
Interaction between personnel and patients is an essential part of any job, including the radiology director. The director provides opportunities for the workers to grow as well as the department itself. If a complaint is there for a worker, they must follow up on it. There is no need to mention that the work of the whole department depends, in a way, on the communicative abilities of each individual.
Preventive Measures for the FCA Violation
Various preventive measures might be useful to avoid FCA violations. First, it is important to develop and promote the code of work ethics including company laws, regulations, and rules. Though, it is to be adequately used: the code should circulate among the workers and suppliers. It can also be a part of any training process. Second, internal audit must be enabled to make sure the company is protected from the wrongful actions of an employee if there are any. The inspection involves one person outside of the department or a position being audited and includes more than one person in total. Third, disciplinary measures may be taken against the FCA violators. Bodenheimer et al. (2016) state, “Most people in the United States believe that health care should be a right,” which, however, is not precisely a right, at the moment (p. 153). Advanced medical services are not free of charge, and if people pay for medical care, there cannot be FCA fraud in the health care system, enriching one person and depriving others of their treatment. It is necessary to make sure the workers are encouraged to report a suspected problem, and the senior manager takes the comments seriously and follows up on them. Any case of a suspected or implemented violation should be detected and corrected timely.
Hence, FCA violations are becoming a serious concern for health care workers across the US. The government covering thousands of payments for various fields of expenses, apart from health care programs, is at risk to pledge money for unnecessary costs. While enriching the violators, FCA violations can deprive those in need of the necessary medical care, cause grave damage to their health, and undermine the whole health system. The FCA law, established in 1863, has undergone several changes, yet still protects the government from the abuse of healthcare programs. Now, it ensures the government budget is allocated fairly, and requires proof of the several elements of violation before being confirmed. Such preventive measures as developing the work ethics code, implementing the internal audit within the department, and applying the disciplinary measures against the violators, if appropriate, would be preferable.
References
Bodenheimer, S. T., & Grumbach, K. (2016). Understanding health policy: A clinical approach (7th ed.). McGraw-Hill Education.
Correll, F. E., Gregory, T. A., Luce, G. M., & Karen A. M. (2017). Litigation services handbook: The role of the financial expert (6th ed.). John Wiley & Sons, Inc.