Health Care Compliance Manager
Dawn Campbell
Healthcare Compliance Manager
Course Project
Ms. Tammy Card
February 23, 2008
“Healthcare Compliance Manager provides career tracks for compliance specialists who are responsible for monitoring health and human services program operations for compliance with federal and state regulations and standards in order to promote health and safety, assure that public services are delivered properly, or prevent fraud. Areas assessed may include service delivery, eligibility determination and payment, medical reimbursement, risk and safety, or operational practices.” Responsibilities range from entry level professional to management. Employees inspecting medical facilities must be licensed as health care professionals. In this paper I will introduce you to an upcoming field of management that is in place for those who have completed a degree in Registered Health Information Technology or Administration. This is a job for those that have an interest in working in a different type of healthcare field instead of working with patients records. I will discuss the job description, responsibilities, challenges, ethical issues, and the career path.
“Fraud is defined as knowingly and willfully executing or attempting to execute, a scheme or artifice to defraud any health care benefit program. Or to obtain, by means of false or fraudulent pretenses, representations or promises, any of the money or property owned by, or under the custody of, or control of, any health care benefit program. While Abuse is defined as receiving payment for items and service when there is no legal entitlement for that payment and the provider has not knowingly or intentionally misrepresented the facts to obtain payment.” These two are similar but all together different. They both can be used interchangeable but can also stand alone. As the Director, Healthcare Compliance, you will be responsible for the development and implementation of a comprehensive compliance program
Healthcare Compliance Manager
Course Project
Ms. Tammy Card
February 23, 2008
“Healthcare Compliance Manager provides career tracks for compliance specialists who are responsible for monitoring health and human services program operations for compliance with federal and state regulations and standards in order to promote health and safety, assure that public services are delivered properly, or prevent fraud. Areas assessed may include service delivery, eligibility determination and payment, medical reimbursement, risk and safety, or operational practices.” Responsibilities range from entry level professional to management. Employees inspecting medical facilities must be licensed as health care professionals. In this paper I will introduce you to an upcoming field of management that is in place for those who have completed a degree in Registered Health Information Technology or Administration. This is a job for those that have an interest in working in a different type of healthcare field instead of working with patients records. I will discuss the job description, responsibilities, challenges, ethical issues, and the career path.
“Fraud is defined as knowingly and willfully executing or attempting to execute, a scheme or artifice to defraud any health care benefit program. Or to obtain, by means of false or fraudulent pretenses, representations or promises, any of the money or property owned by, or under the custody of, or control of, any health care benefit program. While Abuse is defined as receiving payment for items and service when there is no legal entitlement for that payment and the provider has not knowingly or intentionally misrepresented the facts to obtain payment.” These two are similar but all together different. They both can be used interchangeable but can also stand alone. As the Director, Healthcare Compliance, you will be responsible for the development and implementation of a comprehensive compliance program
Cited: Healthcare Compliance Association, the Association for Healthcare Compliance Professionals, Manager of Compliance, February 2008, http://www.hcca-info.org/Content/NavigationMenu/CareerOpportunities/Career_Opportunities.htm Penalties for Health Care Fraud and Abuse, Joe Batte, Health Compliance Specialist, http://www.health-care-compliance.com/news-penalities-for-fraud.htm Fraud and Abuse, Blue Cross and Blue Shield of North Carolina, Types of Healthcare Fraud and Abuse, http://www.bcbsnc.com/inside/fraud/#types Sixth Annual National Congress on Healthcare Compliance, the Sixth Compliance Congress Focuses on New Arenas for the Compliance Professional, Healthcare Conference Administrators, LLC, Copyright 1993-2003 http://www.compliancecongress.com/overview.html