legislation

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The legislation is aimed at maintaining a country’s peace, ensuring high standards of morality, and ensuring change takes place in an orderly manner among others depending on the country. Ethics is one’s ability to decide what is right or wrong. It is vital for health professionals to understand different legislation and other legal issues that affect their practice. Ignorance normally has no defense. The paper presents different types of legislation and bills (pending legislation) that have been put forth over the years on ethics and insurance fraud in the United States of America.
“H.R.3245 Medicare Civil and Criminal Penalties Update Act”
The above legislation was introduced by Rep. Bilikralis. The enacted bill is supposed to increase the civil and criminal penalties and sentences established for those violating the social security act (Bilirakis, 2017). The increased penalties would go a long way in protecting the benefits and provisions of the act which had for the longest time been susceptible to fraud. The enactment would help improve the revenue collected by the board but have less budgetary impacts.
The various aspects of the bill give clear guidance on how to pass punishment for one’s action. These are ethically accepted standards that would offer the society caution when handling health insurance matters. A report on the bill was read out by the energy and commerce committee on the 6th of December 2017. It is still pending as it is yet to be passed by the House committee and Senate before signing by the president.

When signed into law, this legislation will have some effects on occupational therapy. The bill will promote advocacy for people with disabilities. It will protect essential health benefits such as mental health and rehabilitation services.

Understanding this legislation is beneficial for healthcare professionals. For instance, nursing practice takes divergent paths and requires independent decision making. In other words, a nurse doesn’t have to rely entirely on a lawyer to make decisions which relate to certain legal matters. The nurse will be equipped with well-defined ground for disciplinary actions and possible remedies.
“H.R.1021 – Protecting the Integrity of Medicare Act of 2015”
It is another piece of legislation sponsored by Rep. Brady. The bill purposed to foster the security of medical cards given to persons benefitting from the health insurance (Kevin, 2015). It aimed to have the account numbers not embedded on the cards and that also nothing which identifies the cardholder displayed on the card. More so it introduced a cost-saving initiative by adopting us of smart cards (Kevin, 2015). The bill proposed to have a reward system for those who report Medicare fraud. Ideas to create public awareness for the program were also proposed in the bill.
There would be more transparency as the beneficiaries would start getting summary notices electronically create a better understanding between the people who pay for the Medicare and medical providers (Kevin, 2015). All these measures proposed in the bill are ethically accepted to protect the health insurance industry from violations and insurance fraudsters. This bill is still pending discussions by the subcommittee on health. However, parts of the bill were incorporated into others over the periods and had since been signed into law. For instance, there is the “Medicare Access and CHIP Reauthorization Act of 2015” which incorporated aspects from the bill discussed above and has since become public law. Similarly, this bill is expected to have certain effects on occupational therapy practice. In nursing homes, for instance, the legislation will protect the availability of insurance coverage for individuals with pre-existing conditions.
31 U.S.Code § 3729 – False claims
A false claim happens when a person knowingly requests to be paid for a claim that is fraudulent; a person with all the knowledge uses a false record to fraudulent claim (“31 U.S. Code § 3729 – False claims”, 2015). A false claim is also when one with full knowledge uses a false record to enable him/her avoid making required payments to the government. Some violations that constitute the false claims act in healthcare include false billings, false cost reports, kickbacks among others. This bill is to protect the government and government programs from fraudsters.
The false claims act is successful because whistleblowers are also known as relators. More so, there is a provision which allows any person to file a claims case in place of the government (“31 U.S. Code § 3729 – False claims”, 2015). Persons found in violation of the act can be required to pay back triple the value misappropriated plus penalties for each false claim. In addition to civil prosecutions, civil lawsuits can also be filed by whistleblowers. Persons found in violation will also be disqualified from getting future government contracts (“31 U.S. Code § 3729 – False claims”, 2015). This law explained different aspects that could be termed as false claims and penalties pegged to each and by so doing strengthened the code of ethics of the insurance sector pertaining healthcare issues. It was enacted in 1863 and became law. It clarified the ethics and the various relationships of employees, members and all stakeholders like suppliers of medical items. The legislation would protect people with disabilities and the elderly for abuse and any form of exploitation. It will ensure that the people live healthy, independent with fulfilling lives.
“U.S. Code § 1320a–7b – Criminal penalties for acts involving Federal health care programs”
It was put in place to safeguard the healthcare program that was susceptible to fraudsters (Legal Information Institute, 2015). These acts against the program include making false statements for payments under the healthcare program, soliciting or receiving kickbacks and bribes to defraud the healthcare program through illegal purchases, illegal patient admittance, and violation of agreed terms for physicians among others (Legal Information Institute, 2015).
This legislation proposed for heavy fines and sentencing for those found in the examples above. (Legal Information Institute, 2015). The penalties proposed in the law showed the governments seriousness in protecting the healthcare program from insurance fraudsters and create a strong ethical culture in the society. For example acceptance of bribes and kickbacks to process, false claims are unethical behaviors that have serious implications as indicated in the law. The bill may also affect the occupational therapy practice in hospitals. It will enhance service delivery in hospitals by ensuring availability of affordable coverage that takes care of occupational therapy.
In summary, all the four acts discussed above were enacted to safeguard against insurance fraud and protection of the healthcare program by instilling ethical cultures in the society. The fines penalties and sentences for those found in violation had previously been very minimal and hardly any harsh to deter people from committing the crimes. It’s with this that over the years bills were put forth to ensure the security of the program. All these legislations and amendments are aimed to strengthen the healthcare program and seal all loopholes that insurance fraudsters are and have been using (Legal Information Institute, 2015). These laws and regulations also help to foster higher ethical standards in the society. The various aspects in the different legislations provide ethical guidelines in the health insurance sector. Adherence to these high ethical standards helps reduce consequences such as lawsuits and loss of licenses as in the case of false claims. References
False claims. LII / Legal Information Institute.31 U.S. Code § 3729, (2015).
Legal Information Institute. 42 U.S. Code § 1320a–7b – Criminal penalties for acts involving Federal health care programs. LII / Legal Information Institute. (2015).
Medicare Civil and Criminal Penalties Update Act. Congress.gov. Text – H.R.3245 – 115th Congress (2017-2018): (Bilirakis, G. 2017).
Protecting the Integrity of Medicare Act of 2015. Congress.gov. Text – H.R.1021 – 114th Congress (2015-2016): (Kevin, B. 2015).