The federal government also implements mitigating measures and initiatives in combating fraud, waste and abuse in the realm of pharmaceutical companies. Some of the government initiatives are: • “Laws and rules prohibiting fraud and abuse. • Audits and auditors. • Regulators and law enforcement personnel. • Funding for new and existing anti-fraud programs • Investigations and prosecutions. ” (Bell & Kleiman, 2010, n. p. ).
There are a number of newly enacted laws and statutes that are in relation with anti-fraud and abuse. Several states are also becoming stricter with their measures in resolving fraud, waste and abuse in pharmacy. Some states copy the federal laws and apply necessary changes and alterations in their own state. Most states include Qui Tam provisions as well as whistleblower protection to attract more vigilant citizens in fighting against fraud and abuse.
Qui Tam provisions ensures that the person who cooperates in resolving an incident of fraud, waste and abuse will not be subjected to reprisal, reprimand or any disciplinary action that may be taken against him or her for the purpose of retaliation. Moreover, the person cannot be fired or demoted due to reason of being engaged in the vigilant efforts of eliminating fraud, waste and abuse in the company. The anti-fraud, waste and abuse laws are enforced and overlooked by the federal and state authorities as well as third party participants.
These groups include the Office of the Inspector General of the U. S. Department of Health and Human Services, U. S. Department of Justice, Centers of Medicare and Medicaid Services (CMS), and States’ attorneys general. The federal and state authorities formed a special taskforce that focuses on fraud within the Medicare program. This special taskforce is the Health Care Fraud Prevention and Enforcement Action Team (HEAT). All of the cases are liable for penalties such as criminal charges and high value fines.
Moreover, you may be expelled in the government sponsored health care program such as the Medicare and Medicaid. Conclusion Fraud, waste and abuse are some of the controversial issues concerning the field of pharmacy. Because of these crimes, the health care programs and services suffer. There are shortages in supplies and inadequacy in the requirements to compensate the patients’ needs. It is the duty of every employee and every citizen to commit in preventing and abolishing fraud, waste and abuse not only in health care but in all sectors of the society.
It is our responsibility to actively participate in preventive measures and efforts of companies as well as of federal authorities in preventing fraud, waste and abuse. Reference Bell, D. L. & Kleiman, M. E. (2010). Preventing fraud, waste and abuse. LearnSomething, Inc. ; NACDS Foundation, Inc. Podcast Retrieved from https://www. courses. learnsomething. com/scripts2/content. asp? a=9F7B983E559541A692699E4D6709D56D&ph=EC9035F59C904AED99FE0DFDDF9D57B7&r=BeginFlashCourse&screenw=1311&screenh=737