The responsibility for fraudulent claims rests with anyone who “knows or should know” that the services were not provided as claimed, and the penalties can be severe. The Medicare audit can be a horrendous experience. Every medical practice needs a compliance plan to guard against fraud, whether intentional or inadvertent.
In order to avoid this you should:
• Develop standards and procedures for billing and coding
• Designate a “compliance officer” with oversight and responsibility
• Conduct effective training for your employees
• Develop a mechanism for employees to report suspected violations
• Create monitoring and auditing systems
• Investigate problems and take disciplinary action
• Initiate corrective action
HEALTHY LOUISIANA Healthy Louisiana is Louisiana’s name for its new expanded Medicaid program, which provides health insurance coverage to more than 350,000 working Louisianans who could otherwise not afford health care, while bringing both jobs and economic development to the state. On January 12, 2016, Governor John Bel Edwards signed an executive order (JBE 16-01) to begin the process for expanding Medicaid in Louisiana no later than July 1, 2016. Expansion has made Medicaid available to more than 400,000 people living in Louisiana who did not previously qualify for full Medicaid coverage and could not afford to buy private health insurance. By receiving Medicaid coverage, these Louisianans, many of them working adults in important industries like food service and construction, are finally able to get the regular, preventative, and primary care that best promotes health and wellness.
WHO CAN APPLY?
Any adult who meets the eligibility criteria listed below are able to enroll in Medicaid under the expansion.
• Ages 19-64 years old.
• Has a household income less than 138% of the federal poverty level. Visit LDH.LA.gov for more information.
• Doesn’t already qualify for Medicaid or Medicare.
• Must meet citizenship requirement.
To enroll under expanded Medicaid, it is not necessary to have a dependent child in your household. There is no asset test.
La State Med Soc NEW PHYSICIAN’S GUIDE 27
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