The Affordable Care Act (ACA) was enacted to protect consumers from fraud, waste, and abuse in the healthcare system. The ACA’s primary requirement is that healthcare providers establish and maintain an effective compliance program to prevent and detect fraud, waste, and abuse. To meet this requirement, healthcare organizations must implement a compliance program. For example, the organization must appoint a compliance officer and committee, develop written policies and procedures, provide staff training, conduct internal monitoring and audits, enforce disciplinary rules, and regularly evaluate and improve the program. The Saratoga Hospital program includes all of these components, focusing on racial equity in health care. According to Michener (2020), ACA policies aim to address racial disparities in the healthcare sector. Therefore, the inclusion of this item in the programs of medical institutions is an important step.
Another requirement of the ACA is to prevent false diagnoses and treatments for profit. To avoid this, healthcare organizations should regularly provide compliance training for all staff, including physicians, nurses, and administrative staff (Sullivan & Hull, 2019). This training must include not only a medical perspective but also a legal one. The organization should establish a hotline to report potential fraud or abuse and investigate any reported incidents thoroughly.
In addition, the ACA requires reducing opportunities for fraud, waste, and abuse in healthcare. According to Sullivan and Hull (2019), one way to achieve this is to use “cloud-based computing to maintain medical records for everyone” (p. 55). Automation of processes and information technology in patient care will reduce the ability to correct information in records for fraud or waste. In addition, this approach will help to identify and stop existing violations faster by improving data analytics.
References
Michener, J. (2020). Race, politics, and the affordable care act. Journal of Health Politics, Policy and Law, 45(4), 547-566. Web.
Sullivan, C., & Hull, H. (2019). Preserving life and health by preventing fraud in healthcare. Journal of Business and Behavioral Sciences, 31(1), 48-58. Web.