How would a public health system deal with cost containment issues, quality of care issues and potential fraudulent billing of health care providers?
Quality Assurance and fraud issues would be handled through a Quality Assurance Division of the Connecticut Health Care Trust. The Quality Assurance Division would work with a health care provider advisory board to determine pragmatic and cost-effective quality standards which it would use to educate providers. The system educates providers through quality of care standards, rather than managing individual cases. Fraud would be investigated through a system similar to Medicare. Providers whose patterns of care significantly differ from their colleagues in the state would be investigated to determine the basis for these discrepancies in their billing patterns, including fraud. Furthermore, consumers would receive copies of all billing done by their providers and be encouraged to report discrepancies between what the trust was billed for and what services their provider actually provided.
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