The Affordable Care Act (ACA) was aimed at improving our health care system in three main area. These include expansion of consumer protections, reducing the health care costs, and strengthening Medicare. ACA institutes different measures, new rules, and tougher sentences for crimes related to abuse, fraud, and waste. The prevention of fraud, abuse, and waste is not only the responsibility of the government agencies but also involves the providers and suppliers (Clemente et al., 2018). One of the measures that are being implemented in my health care organization is enforcing strict billing policies. The organization focuses on improving the medical billing and coding processes. This is because the clinical documentation is used the basis upon which payers reimburse providers for their services (Clemente et al., 2018). The organization implemented electronic documentation as a second measure for preventing fraud and abuse. Inappropriate and inaccurate coding and documentation can lead to potential health care fraud and abuse investigations. In addition, the facility has enforced stringent screening and enrollment requirements for new providers and suppliers. The procedure involves screening processes for medical providers and suppliers including licensure checks, fingerprinting, and criminal background checks to assess the integrity of the providers and supplier (McGee, Sandridge, Treadway, Vance, & Coustasse, 2018s.

References

Clemente, S., McGrady, R., Repass, R., Paul III, D. P., & Coustasse, A. (2018). Medicare and the affordable care act: fraud control efforts and results. International Journal of Healthcare Management, 11(4), 356-362.

McGee, J., Sandridge, L., Treadway, C., Vance, K., & Coustasse, A. (2018). Strategies for fighting Medicare fraud. The Health Care Manager, 37(2), 147-154. doi:10.1097/hcm.0000000000000204

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