Fraud Control/Regulatory Requirements

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Choose one

Option #1: Fraud Control

Examine Table 19-2 in your textbook and review the statutes, regulatory agencies, and organizations relevant to healthcare fraud (such as the Fraud Enforcement Recovery Act of 2009 [FERA] and the Patient Protection and Affordable Care Act [ACA]). Choose the initiative/organization that you believe has had the biggest impact on healthcare fraud control and write a paper discussing its impact. Consider the following questions:

  • Does this statute/organization prevent or detect fraud?
  • What type of fraud does it prevent/detect?
  • How does it meet the challenges of fraud detection and prevention?

Your paper should be 3 to 5 pages in length (not including the title and reference pages), double-spaced, and in conformance with the CSU-Global Guide to Writing and APA Requirements, and it must include a minimum of three additional sources.

Option #2: Regulatory Requirements and Reporting

Research and determine which regulatory agencies/organizations govern financial reporting and solvency for different types of managed care organizations. Prepare a chart that compares/contrasts the approach of each agency. Your chart should include:

  • A description of each agency
  • The type of healthcare organization impacted
  • Different aspects of its governance

Your chart should be prepared according to CSU-Global Guide to Writing and APA Requirements and include a minimum of three sources.

 
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