Scenario
You work within a healthcare organiza!on as the director of quality, and your chief compliance officer has asked you to create
a memo to be distributed to the en!re organiza!on. They have asked that the memo focus on how an organiza!on can be#er
manage risk to the revenue cycle and healthcare reimbursement by examining ways to reduce fraud, waste, and abuse.
Direc!ons
Create a memo to assess how the following laws and regula!ons can help a healthcare organiza!on reduce fraud, waste, and
abuse and thereby manage risk to the revenue cycle and reimbursement. Also, recommend strategies and technology to help
an organiza!on abide by the laws and regula!ons. Refer to the following laws and regula!ons to guide your response:
False Claims Act
Physician Self-Referral Law
An!-Kickback Statute
An!-Trust Laws
You may refer to the “Ac!vity Reading” resource in the module resources sec!on to be#er understand how a memo is
structured. If you need wri!ng support, access the Online Wri!ng Center through the Academic Support module of your
course.
Specifically, you must address the following rubric criteria:
1. False Claims Act: Analyze the impact of the False Claims Act on the organiza!on’s reimbursement, coding, and
strategic planning. Consider the following ques!ons to guide your response:
What are the provisions of the False Claims Act?
What penal!es could an organiza!on face for viola!ng the Act?
2. Physician Self-Referral Law: Analyze the impact of the Physician Self-Referral Law on a healthcare organiza!on’s
reimbursement, revenue cycle, and strategic planning. Consider the following ques!ons to guide your response:
What are the features of the Physician Self-Referral Law?
How does this law help prevent fraud and abuse in healthcare?
3. An!-Kickback Statute: Analyze the impact of the An!-Kickback Statute on healthcare reimbursement and referrals.
Consider the following ques!ons to guide your response:
How is the An!-Kickback Statute different from the Physician Self-Referral Law?
What kind of financial penal!es would be a#racted by the viola!on of this statute?
