Khiyaanada, Qashinka, iyo Xadgudubka - Caymiska Caafimaadka Maxaliga ah ee Gobolka Washington - CHPW
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Khiyaano, Qashin, iyo Xadgudub

Qiimaha khiyaanada

Ururka Daryeelka Caafimaadka Qaranka ee La Dagaalanka Musuqmaasuqa ayaa ku qiyaasaya in qasaaraha maaliyadeed ee ka dhashay khiyaanada daryeelka caafimaad ay ku saabsan tahay $ 100 milyan maalintii. Khiyaanada, qashinka, iyo xadgudubku waxay lacag ka qaataan barnaamijyada daryeelka caafimaadka waxayna adkeynayaan in la bixiyo daryeelka loo baahan yahay. Waxay sidoo kale kuxirantahay kordhinta kharashyada daryeelka.

Qorshaha Caafimaadka Bulshada ee Washington (CHPW), waxaan u heellan nahay joojinta khayaanada daryeelka caafimaadka, qashinka, iyo xadgudubka. Waa tan sida loo ogaado iyo sida aad u caawin karto.

Waa maxay khayaanada, qashinka, iyo xadgudubka?

Been-abuur

Khayaanada ayaa timaadda marka qof si og oo ula kac ah u soo gudbiyo sheegasho been ah oo keenta lacag-bixinno aan habboonayn.

Tusaalooyinka khayaanada:

  • Biilasha adeegyada aan la bixin.
  • Been abuurka baaritaanka bukaanka si loo caddeeyo habraacyada aan loo baahnayn.
  • Oggolaanshaha dib-u-celinta ee gudbinta bukaanka.

qashinka

Qashinku waa adeegsi xad dhaaf ah oo adeegyo ah ama dhaqanno kale oo, si toos ah ama si aan toos ahayn, u keenaya kharashyo caafimaad oo aan loo baahnayn. Guud ahaan looma tixgeliyo inay sabab u tahay ficillo dayacaad dambiyeed, laakiin ku takrifalka hantida.

Tusaalooyinka qashinka:

  • Dalbashada tijaabooyinka ogaanshaha cudurka ee xad-dhaafka ah.
  • Si xad dhaaf ah booqashooyinka xafiiska.
  • Farmashiye u diraya daawooyinka xubnaha iyaga oo aan xaqiijin inay weli u baahan yihiin.

Xadgudubka

Xadgudubku waa ficil laga yaabo inuu ka dhasho kharash caafimaad oo aan loo baahnayn. Waa marka qof ama hay'ad ay been ka sheegaan xaqiiqooyinka si loo helo lacag bixin, laakiin aan ogaan iyo / ama ula kac loo samayn.

Tusaalooyinka xadgudubka:

  • Lacag-bixin xad-dhaaf ah oo loogu talagalay adeegyada ama sahayda.
  • Bixinta adeegyo caafimaad oo aan loo baahnayn.
  • U aadida dhakhaatiir kala duwan ama qolalka xaaladaha degdega ah si loo helo dawada xanuunka.

Sidee CHPW ula dagaallanto khiyaanada

CHPW waxay u diyaarisay barnaamij tababar oo dhameystiran bixiyeyaashayada, kaas oo ay marin u heli karaan si ay u bartaan sida looga hortago, loo ogaado, loona soo sheego khayaanada.

Waxaan sidoo kale bixinnaa qalab fudud oo khadka tooska ah ah oo xubnaheenna uga warbixin karaan khayaanada, qashinka, ama xadgudubka suurtagalka ah.

Ka warbixi khadka tooska ah

Ka ilaalinta naftaada khayaanada, qashinka, iyo xadgudubka

Raac tilmaamahan fudud ee kaa caawinaya joojinta khayaanada:

  • Sii kaarkaaga Aqoonsiga Qorshaha Caafimaadka Bulshada ee Washington ama nambarka aqoonsiga kaliya a daryeel caafimaad, rug caafimaad, ama isbitaal.
  • Sii aqoonsigaaga oo keliya markaad daryeel helayso.
  • Weligaa qofna yuusan u deyn kaarkaaga Aqoonsiga Caafimaadka ee Beesha ee Washington.
  • Weligaa ha saxeexin a foomka caymiska maran.
  • Had iyo jeer diyaar u noqo inaad muujiso Aqoonsiga sawirka markaad hubinaysid ballanta caafimaadka.
  • Ka taxaddar bixinta waxaaga Lambarka Amniga Bulshada.

Fahamka sharciyada khuseeya

Xeerka Sheegashada Beenta Madaniga ah ee Federaalka (FCA)

FCA madaniga ah (31 Xeerka Maraykanka (USC) Qaybaha 3729-3733), waxay ka ilaalisaa dawladda Faderaalka in lagu dalacsiiyo ama laga iibiyo alaab ama adeeg aan tayadoodu wanaagsanayn. FCA madaniga ah waxay ku soo rogtaa masuuliyad madani ah qof kasta oo si ula kac ah u soo gudbiya, ama keena soo gudbinta, sheegasho been abuur ah ama been abuur ah oo ku socota Dowladda Federaalka.

Erayada "ogaan" iyo "ogaal" waxay ka dhigan yihiin in qofku aqoon dhab ah u leeyahay macluumaadka ama ku dhaqmo jaahilnimo ula kac ah ama iska indho-tirin la'aanta runta ama been-abuurka macluumaadka la xidhiidha sheegashada. Ma jirto ujeedo gaar ah oo lagu khiyaameynayo si loogu xad gudbo FCA madaniga ah.

Tusaalayaal: Dhakhtarku si badheedh ah ayuu u soo gudbiyaa sheegashooyinka Medicare ee adeegyada caafimaad ee aan la bixin ama heer ka sareeya adeegyada caafimaadka ee la bixiyo.

Ciqaabta: Ciqaabaha madaniga ah ee ku xadgudubka FCA madaniga ah waxaa ka mid ah soo kabashada ilaa iyo saddex inta jeer ee khasaaraha ay soo gaadhay Dawladdu ee ka dhalatay sheegashooyinka beenta ah, iyo ganaaxyada maaliyadeed ee dacwad been ah oo la xareeyay.

Intaa waxaa dheer, hoos yimaada FCA dembiilaha (18 USC Qaybta 287)Shakhsiyaadka ama hay'adaha waxa laga yaabaa inay wajahaan ciqaab ciqaabeed ah inay soo gudbiyaan sheegashooyin been abuur ah, khiyaali ah, ama been abuur ah, oo ay ku jiraan ganaax, xadhig, ama labadaba.

Xeerka sheegashooyinka beenta ah waxa uu u ogolaanayaa dadka aan ku xidhnayn dawladda in ay fayl-gareeyaan falalka ay ku andacoonayaan khiyaano ka dhan ah qandaraasle dawladeed oo wakiil ka ah dawladda:

  • U soo bandhigida dawladda dacwad been abuur ah oo lacag bixin ah
  • Ku keenista qof kale inuu soo gudbiyo cabasho been abuur ah oo lacag bixin ah
  • Samaynta ama isticmaalka rikoodh ama qoraal been abuur ah si aad u hesho cabasho ay bixiso dawladdu
  • Shirqool lagu helo sheegasho been abuur ah oo ay dawladdu bixiso
  • Samaynta ama isticmaalka rikoodh been abuur ah si looga fogaado ama loo dhimo waajibaadka bixinta ama magdhawga dawladda

Xeerka sheegashooyinka beenta ah waxa uu ilaaliyaa "cadayaasha" Qofka sirta faafiya waa qofka keena walaac ku saabsan khaladka ka dhaca urur ama dad, badanaaba isla ururkaas. Ilaalinta sirta

  • U ogolow shakhsiyaadka inay ka warbixiyaan khiyaanada iyagoon la aqoonsan, dacweeyaan hay'ad magaca dawladda, oo ay ururiyaan qayb ka mid ah xalinta natiijada.
  • Ka mamnuuc loo-shaqeeyayaasha inay handadaan, caga-jugleeyaan, ama ka aargoostaan ​​shaqaalaha, kuwaas oo si daacad ah uga warbixiya anshax-xumo ama fal-dambiyeed.

Ku xad-gudbida sharciga sheegashooyinka beenta ah waxay ka dhashaan cawaaqib bulsheed iyo ganacsi, taasoo keenta dhaawac aan laga soo kaban karin oo soo gaara sumcadda qofka, iyo luminta ganacsiga. Intaa waxaa dheer, xadgudubyadu waxay keeni karaan ganaaxyo madaniga ah iyo kuwa lacageed, oo ay ku jiraan:

  • Ciqaabaha madaniga ah, sida lagu hagaajiyay Xeerka Sicir bararka Ciqaabta Madaniga ah ee Federaalka ee 1990 (28 SC 2461 note: Law Public 104-410)
  • Ka-reebista ka-qaybgalka Medicare iyo Medicaid
  • Intaa waxaa dheer, khasaaraha saddex geesoodka ah ee soo gaadhay dawladda
  • Dacwooyin dembi oo suurtagal ah iyo xadhig
  • Qiimaha tijaabada

Tixraac https://www.govinfo.gov/app/details/USCODE-2011-title31/USCODE-2011-title31-subtitleIII- cutubka37-subchapIII-sec3730

Xeerka Ka-hortagga Laadka (AKS)

AKS (42 USC Qaybta 1320a-7b(b)), waxay dembi ka dhigaysa in si badheedh ah oo badheedh ah loo bixiyo, la bixiyo, la dalbado, ama loo helo wax gunno ah si toos ah ama si dadban si loogu dhiirrigeliyo ama loo abaalmariyo gudbinta bukaanka ama jiilka ganacsiga ku lug leh shay kasta ama adeegga uu bixinayo barnaamijka daryeelka caafimaadka Federaalka. Marka adeeg bixiye bixiyo, bixiyo, dalbado, ama helo gunnooyin sharci darro ah, bixiyaha wuxuu ku xad gudbaa AKS.

FIIRO GAAR AH: Gunnada waxaa ku jira wax kasta oo qiimo leh, sida lacag caddaan ah, kiro bilaash ah, hudheelo qaali ah iyo cuntooyin, iyo magdhowga xad-dhaafka ah ee agaasimayaasha caafimaadka ama la-talinta.

Tusaale: Bixiyuhu waxa uu helayaa lacag caddaan ah ama kiro qiimo jaban oo ka hooseeya suuqa oo loogu talagalay boos xafiis caafimaad oo loogu beddelo gudbinta.

Ciqaabta: Ciqaabaha ciqaabta iyo ciqaabta maamul ee ku xadgudubka AKS waxa ku jiri kara ganaax, xadhig, iyo ka-reebis ka-qaybgalka barnaamijka daryeelka caafimaadka dawladda dhexe. Marka loo eego CMPL, ciqaabta ku xadgudubka AKS waxa ku jiri kara saddex jeer inta ay le'egtahay laadka.

Xeerarka "deked badbaado leh" (42 CFR Qaybta 1001.952), sharax lacag-bixino kala duwan iyo dhaqamo ganacsi kuwaas oo, in kasta oo ay suurtogal tahay in ay ku lug leeyihiin AKS, aan loola dhaqmin sidii dembi marka loo eego AKS haddii ay buuxiyaan shuruudaha qaarkood ee lagu qeexay qawaaniinta. Shakhsiyaadka iyo hay'adaha ayaa mas'uul ka ah u hoggaansanaanta dhammaan sharciyada kale, qawaaniinta, iyo hagidda ee khuseeya ganacsigooda.

Tixraac  https://www.govinfo.gov/app/details/USCODE-2010-title42/USCODE-2010-title42-chap7-subchapXI- qaybtaA-sad1320a-7 or https://oig.hhs.gov/compliance/safe-harbor-regulations/ ilaalinta deked nabdoon.

Is- Gudbinta Dhakhtarka (Sharciga Stark)

Sharciga Is- Gudbinta Dhakhtarka (42 USC Qaybta 1395nn), oo inta badan loo yaqaan Sharciga Stark, ayaa ka mamnuucaya dhakhtarka inuu u gudbiyo bukaanada si ay u helaan "adeeg caafimaad oo loo qoondeeyey" oo ay bixiyaan Medicare ama Medicaid halbeeg kaas oo dhakhtarka ama xubin ka mid ah qoyska dhakhtarka uu la leeyahay xidhiidh dhaqaale, ilaa marka laga reebo khusayso.

Tusaale: Dhakhtarku wuxuu u gudbiyaa ka-faa'iideyste adeeg caafimaad oo loo qoondeeyay xarun caafimaad oo uu takhtarku leeyahay dano maalgashi.

Ciqaabta: Ciqaabaha takhaatiirta ku xad gudubta Sharciga Stark waxaa ku jiri kara ganaaxyo, CMP-yada adeeg kasta, dib u bixinta sheegashada, iyo ka saarida suurtagalka ah ee ka qaybgalka barnaamijyada daryeelka caafimaadka ee Federaalka.

Macluumaad dheeri ah, tixraac https://www.govinfo.gov/app/details/USCODE- 2010-title42/USCODE-2010-title42-chap7-subchapXVIII-partE-sec1395nn.

Xeerka Khiyaanada Daryeelka Caafimaadka Dembiyada

Xeerka Khiyaanada Daryeelka Caafimaadka Dembiyada (18 USC Qaybta 1347) mamnuucaya si badheedh ah oo ula kac ah, ama isku dayga in la fuliyo, qorshe ama been la xidhiidha bixinta, ama bixinta, faa'iidooyinka daryeelka caafimaadka, alaabta, ama adeegyada midkood:

  • Khayaano barnaamij kasta oo daryeelka caafimaadka ah
  • Ku hel (iyada oo la adeegsanayo is yeelyeel been ama been abuur ah, matalaad, ama ballanqaad) mid kasta oo ka mid ah lacagta ama hantida ay leedahay, ama ay maamusho, barnaamij kasta oo daryeelka caafimaadka

TusaaleDhawr takhaatiir iyo rugaha caafimaadka ayaa qorsheeyey qorshe la isku duba riday si ay u khiyaameeyaan Barnaamijka Medicare iyaga oo soo gudbinaya dacwooyin aan loo baahnayn oo caafimaad ahaan kuraasta curyaanka ah.

CiqaabtaCiqaabaha ku xad-gudbida Xeerka Khiyaanada Daryeelka Caafimaadka Dembiyada waxa ku jiri kara ganaax, xadhig, ama labadaba.

Xeerka Ka Saaridda

Xeerka Ka Saaridda (42 USC Qaybta 1320a-7), waxay u baahan tahay OIG inay ka saarto shakhsiyaadka iyo hay'adaha lagu xukumay mid ka mid ah dembiyada soo socda ka qaybgalka dhammaan barnaamijyada daryeelka caafimaadka Federaalka:

  • Medicare ama Medicaid khiyaano, iyo sidoo kale dembiyada kale ee la xiriira bixinta alaabta ama adeegyada hoos yimaada Medicare ama Medicaid.
  • Xadgudubka ama dayaca bukaanka.
  • Dembi-dembiyeedka khiyaanada, xatooyada, ama dhaqan-xumada maaliyadeed ee kale ee la xidhiidha daryeelka caafimaadka.
  • Xukunka dambiga ah ee soo saarista sharci darrada ah, qaybinta, qorida, ama bixinta walxaha la xakameeyey.

OIG waxaa laga yaabaa inay ku soo rogaan ka-saarid oggolaanshaha sababo kale, oo ay ku jiraan:

  • Dembi-xumada la xidhiidha khiyaanada daryeelka caafimaadka ee aan ahayn Medicare ama Medicaid khiyaanada, ama xukun-dembiyeedka sharci-darrada ah ee wax-soo-saarka, qaybinta, qorida, ama bixinta walxaha la xakameeyey.
  • Joojinta, kala noqoshada, ama dhiibista shatiga si loo bixiyo daryeel caafimaad sababo la xiriira kartida xirfadeed, waxqabadka xirfadeed, ama daacadnimada maaliyadeed.
  • Bixinta adeegyo aan loo baahnayn ama tayadoodu liidato.
  • U gudbinta sheegashooyinka beenta ama been abuurka ah ee barnaamijka daryeelka caafimaadka Federaalka.
  • Ku hawlgelinta qorshayaasha dib-u-celinta ee sharci-darrada ah.
  • Defaftirka deynta waxbarashada caafimaadka ama waajibaadka deeqda waxbarasho.

Bixiyeyaasha laga saaray waxaa laga yaabaa in aanay ka qayb qaadan barnaamijyada daryeelka caafimaadka ee dawladda dhexe muddo cayiman. Haddii OIG lagaa saaro, markaa barnaamijyada daryeelka caafimaadka dawladda dhexe, oo ay ku jiraan Medicare iyo Medicaid, kuma bixin doonaan alaabta ama adeegyada aad bixiso, dalbato, ama qorto. Bixiyeyaasha laga saaray waxaa laga yaabaa in aysan si toos ah u dalacsiinin daaweynta bukaannada Medicare iyo Medicaid, iyo loo-shaqeeyaha ama koox-shaqeeye ma dalacsiin karo adeegyada bixiyaha laga saaray. Dhammaadka xilliga ka-saarista, bixiyaha laga saaray waa inuu raadsadaa dib u soo celinta; dib u soo celinta si toos ah uma aha.

Bixiyeyaasha CHPW ee qandaraaska haysta waa in ay eegaan shakhsiga iyo hay'adaha ay shaqaaleysiiso ama qandaraasyada ay kula jirto Liisaska Shakhsiyaadka iyo Hay'adaha Laga Reebay (LEIE) ee ay hayso Wasaaradda Caafimaadka iyo Adeegyada Aadanaha (HHS) Xafiiska Kormeeraha Guud (OIG) http://oig.hhs.gov/exclusions/ iyo Nidaamka Maareynta Abaalmarinta (SAM) ee ay hayso Maamulka Adeegyada Guud ee Maraykanka (GSA) ee https://www.sam.gov/

Sharciga Ciqaabta Lacagta Madaniga ah (CMPL)

CMP (42 USC Qaybta 1320a-7a) Waxay u ogolaataa OIG inay raadsato CMP-yada iyo mararka qaarkood ka saarida xadgudubyada kala duwan ee daryeelka caafimaadka. Xaddi kala duwan oo ganaax iyo qiimayn ah ayaa lagu dabaqaa iyadoo lagu salaynayo nooca xadgudubka. CMPs waxa kale oo laga yaabaa inay ku jiraan qiimaynta ilaa saddex jeer lacagta la sheegay shay ama adeeg kasta, ama ilaa saddex jeer qaddarka gunnada la bixiyo, la bixiyo, la codsado, ama la helo. Xadgudubyada sabab u noqon kara CMPs waxaa ka mid ah:

  • Soo bandhigida sheegasho aad ogtahay, ama ay tahay inaad ogaato, waa shay ama adeeg aan loo bixin sida la sheegay ama been iyo been abuur ah.
  • Ku xadgudubka AKS

Samaynta hadalo been abuur ah ama been abuur codsiyada ama qandaraasyada ka qaybgalka barnaamijyada daryeelka caafimaadka ee dawladda dhexe

Xaqiiqooyin kale

Liiska horudhaca

CMS waxay leedahay Liis Hordhac ah oo wax ku ool u ah sheegashooyinka leh taariikhaha adeegga Abriil 1, 2019 ama ka dib.

Liiska ka-hortagga wuxuu ka kooban yahay liiska qorayaasha iyo shakhsiyaadka ama hay'adaha kuwaas oo:

  • Lagala noqday Medicare, waxay ku hoos jiraan bar isdiiwaangelineed oo firfircoon waxayna CMS go'aamisay in dhaqanka hoose ee keenay ka noqoshada uu dhaawac u yahay danaha ugu wanaagsan ee barnaamijka Medicare.
  • Ku hawlan yihiin habdhaqan ay CMS ka xayuubin karto qoraaga, shakhsiga ama hay'adda ilaa inta ay suurtogal tahay haddii ay ku qornaayeen Medicare iyo in dhaqanka hoose ee u horseedi lahaa ka noqoshada uu dhaawac u yahay danaha ugu wanaagsan ee barnaamijka Medicare.
  • Lagugu xukumay dambi culus sida waafaqsan sharciga dawlada dhexe ama gobolka 10kii sano ee la soo dhaafay iyo in CMS ay u aragto inay wax u dhimayso danaha ugu wanaagsan ee barnaamijka Medicare.

Bixiyeyaasha daryeelka caafimaadku waxay ka helaan warqad CMS ogaysiinaysa meelayntooda Liiska Preclusion. Waxay rafcaan ka qaadan karaan CMS ka hor inta aan ka-hortaggu dhaqan gelin. Ma jirto fursad aad racfaan uga qaadan karto CHPW. CMS waxay cusbooneysiisaa Liiska Horudhaca bil kasta waxayna ogaysiisaa MA iyo Qaybta D qorshooyinka taariikhda diidmada, taariikhda aan diidno ama diidno sheegashada bixiyaha daryeelka caafimaadka xaalad la diiday awgeed. Marka taariikhda diidmada sheegasho ay hirgasho, sheegashada bixiyaha xanaanada caafimaadka ee la diiday lama bixin doono, sheegashooyinka farmashiyaha waa la diidi doonaa, bixiyaha xanaanada caafimaadkana waa laga joojin doonaa shabakada CHPW. Intaa waxaa dheer, bixiyaha xanaanada caafimaadka ee laga reebay waa inuu hayaa ka-faa'iideystayaasha Medicare dhib la'aan mas'uuliyadda maaliyadeed ee adeegyada la bixiyo taariikhda diidmada ama ka dib.

Adiga oo ah bixiyeyaasha daryeelka caafimaadka ee qandaraaska ku haysta CHPW, waa in aad hubisaa in lacagaha adeegyada daryeelka caafimaadka aan la siin shakhsiyaad ama hay'ado ku jira Liiska Preclusion, oo ay ku jiraan shaqsiyaadka ama hay'adaha shaqeeya ama qandaraasleyaasha ah.

Macluumaad dheeri ah oo ku saabsan Liiska Kahortagga, booqo cms.gov

Ka-baxsanaanta Medicare

Waxaan raacnaa, waxaanan uga baahanahay daryeel bixiyayaashayada inay raacaan, shuruudaha Medicare ee takhaatiirta iyo dhakhaatiirta kale ee ka baxa Medicare. Haddii aad ka baxdo Medicare, waxaa laga yaabaa inaadan aqbalin lacag celinta federaalka. Bixiyeyaasha daryeelka ee ka baxay Medicare (iyo kuwa aan ka qayb qaadanayn Medicare) looma ogola inay biil u soo diraan Medicare ama qorshaheeda manfaca MA inta lagu jiro mudada ka bixitaankooda muddo laba (2) sano ah laga bilaabo taariikhda ka bixida rasmiga ah.

Xubinnimadayada MA, anaga iyo hay'adaha naloo igmaday qandaraas lama siin, mana bixinno sheegashooyinka, bixiyayaasha daryeelka ee ka baxay Medicare. Marka laga reebo: Xaalad degdeg ah ama xaalad daryeel degdeg ah, haddii aad ka baxday Medicare, waxaa laga yaabaa inaad daaweyso ka-faa'iideyste MA oo aad biilka daawaynta ku bixiso. Xaaladdan oo kale, waxaa laga yaabaa inaadan ku dalacin xubinta wax ka badan waxa loo ogol yahay bixiyaha xanaanada aan ka qayb qaadanay. Waa inaad noo soo gudbisaa dacwad anaga oo xubin ka ah magaca. Waxaanu bixinaa Medicare-ka alaabta ama adeegyada lagu diyaariyey xaaladaha degdega ah ama degdega ah.

Ka warbixi khayaanada iman kara

Markaad ka warbixiso xaalad khiyaamo dhici karta, waxaad gudaneysaa qaybtaada si aad u horumariso nidaamka daryeelka caafimaadka. Haddii aad ka shakisan tahay wax isdabamarin, qashin, ama xadgudub, waxaad noogu soo sheegi kartaa khadka tooska ah:

Ka warbixi khadka tooska ah

Ama emayl, mail, ama fakis:

Warbixinta Khayaanada ee laga yaabo

Haddii aad wali su'aalo ka qabtid khayaanada daryeelka caafimaadka, fiiri ilaha hoose:

MA OGEYD...?

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☏ SU'AALO MA LEH?

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