As it is with many other nations, the reforms in the health care system in America undoubtedly ensure that citizens live more productively, healthy and longer lives. It is against this reason that the government has made it a priority to issue many health related services to the public. These include health information, control of contagious diseases, immunization of children, discouraging negative behaviors that are cost effective and of negative externalities as well as encouraging beneficial behavioral patterns. In addition, the government offers affordable health services to the poor (Anon., 2001). Through financing of health sector, the public is able to access medical health and pay medical bills that the government subsidizes. However, there are instances where issues of fraud have found their way in the health care market (Cascardo, 2009). This essay will compare and contrast the roles of the General Accounting office (GAO), the Office of Inspector General (OIG) and the Quality Improvement Organization (QIO).
Quality improvement organizations are private organizations of the federal government that monitor the effectiveness, quality and appropriateness of health care that is provided to the beneficiaries of the health system (Lanier et al., 2003). Quality Improvement Organization works under the Center for Medicare and Medicaid Services (CMS) (Anon., 2001). Through QIO, there has been great improvement in the health care services. It has been able to audit and inspect Medicare activities (Lanier et al., 2003). In addition, it is concerned with quality assurance and transformational change in the health sector. According to the organisation, this can be attained by raising the standards of performance, incorporating technology in health information and accelerating health improvement rates. Apparently, this organisation is the most important of the three since it performs the overall responsibility of ensuring that health standards are up to date. Besides, its activities are spread across the board and affect the other two organizations.
Moreover, QIO has improved quality Medicare by the adoption of information technology and electronic health record systems through the federal Doctors Office Quality Information Technology initiative (DOQ-IT) (Lanier et al., 2003).This is aimed at making it easy for the hospital to access patient’s information, reference data and information on decision support. The information regarding the patient in the hospital will also help improve the relationship between the patient and the clinical officer (Ogrosky & Kracov, 2010).
Moreover, while working under the CMS, QIO has come up with a project that aims at lowering deadly results that would come after a surgical operation (Ogrosky & Kracov, 2010). The project is referred to as Surgical Care Improvement Project (SCIP) and it has received support from the American College of Surgeons (ACS), American Hospital Association (AHA) and Center for Disease Control (CDC) and many other societies (Cascardo, 2009).
Government Accountability Office (GAO) is the arm of United States Congress that investigates, evaluates and audit all matters in the government relating to public funds, and its use after it has been disbursed (Anon., 2001). It is lead by the Controller General of the United States and it investigates the spending of money paid by the taxpayer. It does this by determining whether funds have been spent properly and efficiently through audits (Ogrosky & Kracov, 2010). Also it investigates activities that are improper and illegal. In the course of its duties, it gives reports on the progress and achievements of government programs as well as issuing agency rules, opinions and legal decisions.
Lastly, the Office of Inspector General (OIG) has come up with a compliance plan to combat abuse and fraud in Medicare. It works to ensure that all physicians do the right things by giving them guidelines to assist them monitor their daily activities, correct their errors, and get their documents and coding faster. The OIG does the role of monitoring the activities of physicians (Ogrosky & Kracov, 2010).
OIG has enforced HIPAA to prosecute health providers and employees who for personal reasons are inappropriately using confidential information from medical records (Cascardo, 2009). The employees are prohibited from disclosing personal health information of a patient for malicious intent or personal gain.
OIG has come up with a compliance plan which is a medical practice’s defense against ethical and legal misconduct (Ogrosky & Kracov, 2010). Every health officer or employee has the responsibility to stop fraud through adhering to certain codes of conduct.
In summing up, these institutions are important in running of Medicare in United States. They ensure accountability and also control the activities of the medical staff as well as the federal spending of taxpayer’s money. They offer rules and codes of conduct and protects against fraud. However, it is important to note that the GAO performs functions that cover parts of the OIG and QIO (Lanier et al., 2003). In addition to this, its borders of work extends to advising the heads of executive agencies and the congress on how the government can be made responsive, ethical, equitable, more effective and efficient (Ogrosky & Kracov, 2010). This ensures that government operations are improved, saving both the taxpayer and the government billions of dollars.
References
Anon. (2001). GAO recommends improving management of NPDB. Healthcare Financial Management. 55 (1), 11.
Cascardo, D. (2009). OIG Demands Transparency for Physicians and Staff in 2010: Welcome to the Modern Era of Compliance. The Journal of Medical Practice Management : MPM. 25(3), 156-159.
Lanier, C. et al. (2003). Doctor performance and public accountability. The Lancet, 362(9393), 1404-1408.
Ogrosky, K., & Kracov, D. (2010). The impact of reform on health care fraud enforcement. The Brief. 40(1), 45-51.