88%(8)7 out of 8 people found this document helpful
This preview shows page 2 - 4 out of 6 pages.
false billing before a payment is ever made by the company. The key is to develop a strong compliance program when it comes to preventing health-care fraud and abuse activities. Everyone is human and mistakes can be made. Nurses can help with the assist in the prevention of healthcare fraud by making sure they are educated about this issue and what is considered
3FLOW OF FUNDS fraud. They can bring it to the physician's attention that it could be healthcare fraud and then if the physician decides to ignore them at least we know we tried to save them from lawsuits or even prison time. We can be involved and help correct the issues. The flow of Funds in OrganizationThe 21st-century healthcare sector is characterized by several health reforms that are meant toensure that every person has access to good health and at a cheaper cost (Arsalan, 2018). Private pay has been almost completely replaced by insurance companies or third-party payers. Payments from third parties can also come with problems such as through fraud. Fund balance is the sum of all an organization's cash outflows and inflows. Private pay is when a patient decides to pay for his or her medical expenses. This is how a lot of people use to pay for their medical expenses back in the day. This form of payment is the most acceptable to the hospital if they do pay for their medical expenses. The organizations usually track the numbers monthly or quarterly. Doctors and hospitals must meet specific criteria focusing on chronic disease prevention and management. Providers can charge the most when they concentrate on preventivecare to keep patients safe. Challenges Faced with Private InsurancePrivate insurance is not cheap for consumers due to high premiums. Even for healthy young people, it can be very expensive which makes them not even want to throw their money away.