A false claim can be defined as the false demand or request for some amount of money from the US government. The False Claim Act is an act that was established to curb the occurrence of false claims. There are elements pertaining to the establishment of a false claim. A false claim can be established when a person intentionally presents or assists in the presentation of a claim, which is not genuine to get some payment or approval.
An entity can make a false claim through using or even backing up the utilization of a record that is incorrect or genuine so as to make a false claim. If a person intends to violate the False Claim Act or falsely certify the type or amount of property to be used by the government, he or she is also liable for a false claim. The other element is certification of a receipt or property or a document without fully knowing that the information is correct.
HIPAA privacy standards ensure that health information is protected from unauthorized disclosures or uses. HIPAA was established to accomplish three main objectives. The main objective is to clearly state under which conditions and circumstances protected health information can be disclosed for use. Under this objective, a covered entity may not use or describe protected health information unless under some certain circumstances (Myers, 2008).
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As a clinical social work association report points out that second objective is the establishment of individual rights in connection with protected health information. Some of the individual rights include the right to be informed when one’s protected health information is to be disclosed for any health or even marketing and fundraising purposes. The last objective is to ensure that proper measures are taken by the administration in order to safeguard patients’ protected health information.
As Watnik and Vincze (1995) explain, there are prohibitions to physicians providing designated health services (DHS) to some entities with financial relationships. These include services such as the ones laboratory operations; counseling both physically and occupationally and pathology services; services such as x-rays and imaging and radiology; therapy through radiation ; provision of medial equipments and supplies which can be termed as durable; parenteral and enteral nutrients; equipments and materials; prosthetics, orthotics and prosthetics devices and supplies; home health services; prescribing drugs both to outpatients and inpatients; offering hospital services both to outpatients and inpatients.
Qui Tam, HIPAA Privacy Rule and EMTALA are all compliance programs, which ensure that people or institutions comply with various rules and standards, which have been agreed upon by the US government. Qui Tam is a provision under False Claim Act, which allows the individual, who discovers and reports a false claim, to get a portion of fines and recoveries that will be made on behalf of the US government.
Health Insurance Portability and Accountability Act (HIPAA) is an act, which was put into use in order to address security and privacy of data related to health matters. HIPAA clearly defines standards for any electronic data transactions regarding health matters nationally. The main goal of HIPAA Privacy Rule is the provision of rights and protection of private health information belonging to clients.
The Federal Emergency Medical Treatment and Active Labor Act (EMTALA) is an act, which guides medical operations that can be termed as emergency cases in any hospital that participates in a federal health program. It ensures that any person, who requests an emergency in any hospital, is attended to, whether one has the financial ability to pay for the services and treatment or not.