Dishonest Care Fraud: White-Collar Crimes

Why discuss the development of the marketplace? Why is it central to the concept of white-collar crime?

According to the book, “The term trust refers to the confidence in a relationship that the other party will act honorably and fulfill legitimate expectations” (Friedrichs 9). Individuals put their faith in a corporation or individual because some people want to see the best in people. “We put our faith in the banks that store our money, the corporations that employ us, the retail stores where we purchase our items, a stockbroker in which we invest in and so much more” (Friedrichs 9). The book is trying to tell us that trust is involved in everything that we do every day. In the book it also states that, “trust and it violations are certainly key elements in white collar crimes” (Friedrichs 9) Trust between two individuals can be broken.. According to the FBI, “white collar crimes are not dependent on threat or physical violence” (FBI). The FBI wants us to note that corporations or individuals do not threaten anyone or physically harm the individual. Wells Fargo is a perfect example of trust and white collar crimes. Wells Fargo

Health care fraud and abuse is a significant contributor to high health care spending, resulting in the wasteful spending of health care dollars. The Federal Bureau of Investigation (FBI) and National Health Care Anti-Fraud Association (NHCAA) estimates that 3 to 10 percent of health care dollars are lost to fraud and abuse (Federal Bureau of Investigation, 2010). Fraud is the intentional deception or misrepresentation that an individual knows to be false or does not believe to be true and makes, knowing that the deception could result in some unauthorized benefit to themselves or some other person (Ryan, 2006). Bloomberg reports health care expenditures are rising faster than the rate of inflation and spending in the US has nearly doubled in the last decade and one-half of health care

Embezzlement seems to be a white collar crime that is victimless. However, when monies are embezzled from a non profit it affects all those involved especially those benefitting from the work of the nonprofit organization. I thought of our local community nonprofit arts foundation. They not only produce a full slate of shows each season, but also provide classes in painting, sculpting, drawing, acting, music, and dance. If they were defrauded in the amount of $93,000 it would affect educational programs and community outreach.

When providers or patients submit false or misleading information intentionally to a health plan, this is fraud. Some examples of healthcare fraud and abuse include filing claims for services or medications not actually performed or obtained, billing for services for non-covered items using codes for billable services or items, altering medical records, waiving co-pays and deductibles, up coding and unbundling, using someone’s insurance card, billing Medicare patients at a higher fee than non-Medicare patients, and accepting kickbacks for referring patients, to name just a few. Fraud can be committed by hospitals, medical providers, laboratories, pharmacists, billing services, medical equipment suppliers, and even patients. Patients can protect themselves from healthcare fraud and abuse by knowing their healthcare benefits, reviewing the explanation of benefits, asking the doctor to explain the service that was given, report discrepancies, protect insurance cards and member identification numbers, beware of free services, report copayment and deductibles being waived, and never sign blank insurance forms.

Medicare fraud is becoming a huge problem in today’s society. Medicare is a health insurance program for personnel paid by taxes the American population contributes to for personnel 65 years or older. When a health care provider, health suppliers, and private health companies deliberately bill Medicare for supplies or services that were not given is considered Medicare Fraud. To include, when a person uses another person’s Medicare card to receive health care for which the person does not qualify for. An individual, company, or a group can commit a Medicare fraud scheme.

The amount listed is the enrollment agreement was 10,020.00 which gives a difference of :

Medical fraud and abuse is a huge contributing factor in the rise of healthcare costs in the United States. Although there are many definitions of fraud and abuse, according to Cigna and HIPPA, Medical fraud is false representation of a substance, device or therapeutic system as being beneficial in treating a medical condition, diagnosing a disease, or maintaining a state of health. Medical Abuse is defined as any action that intentionally harms or injures another person. It also involves actions that are inconsistent with accepted, sound medical, business or fiscal practices. Abuse directly or indirectly results in unnecessary costs to medical programs through improper payments. Insurance fraud occurs when companies

What is Medicare fraud? ("F&A," 2011, p. 1) states “Medicare fraud happens when Medicare is billed for services or supplies you never got. Medicare fraud costs Medicare a lot of money each year.” What is Medicare abuse? ("F&A," 2011, p. 1) defines this as “Abuse occurs when doctors or suppliers don’t follow good medical practices, resulting in unnecessary costs to Medicare, improper payment, or services that aren’t medically necessary.”

(Jones and Jing) Though citizens might not see the effects of health care fraud directly, everyone is impacted in one way or another either through increased taxes, high insurance costs, or the inability to afford health care coverage. While we all hear about major frauds in the system, a majority of the frauds are small and usually go through undetected, unreported, or seriously underreported. (Sparrow) These small frauds add up to be a huge problem. There is a large spectrum of frauds in the health-care systems ranging from the theft of a wheelchair, to organized crime groups that steal patient information and bill for phantom services in multimillion-dollar schemes. (Jones and Jing) In many cases, the fraud is minor but all the small scams add up to an enormous loss to the public. For example, the frequent occurrences of forging of a doctor’s signature on a prescription accounts for billions of dollars lost each year. (Jones and Jing) One of the most common crimes involves billing for services that were never performed. This involves a health care provider submitting a false claim to be paid for a patient that was never treated or adding on services to a patient. For example a doctor may obtain names of other people such as a patients spouse or child who are covered by insurance and put in a claim for them as well as the actual patient. (FBI) Another common fraudulent activity involves upcoding of services. This is when a healthcare

The date of service should never be change. In order for the insurance to pay (if they accept to do it), billing should re-submit the claim with the information about that office visit. Medicare usually has a retroactive effective date for Part B premiums, which can be deducted from the lump sum of the SSDI. In some cases, then there may be Medicaid eligibility for a period of time and again, any services obtained during that time could be paid by Medicaid. If Nancy takes a chance and change the date and this action is made, it can lead to an investigation under Medicare Fraud. Medicare claims must be filed no later than 12 months after the date when the services were provided. If a claim isn't filed within this time limit, Medicare can't

Most people, when they hear the word “crime,” think about street crime or violent crime such as murder, rape, theft, or drugs. However, there is another type of crime that has cost people their life savings, investors’ billions of dollars, and has had significant impacts of multiple lives; it is called white collar crime. The Federal Bureau of Investigation defines white collar crime as

Healthcare fraud is costly for everybody, as it harms the reputation of the institution or physician committing it, and financially damages the patient being affected.By definition fraud may be defined as intentionally employing surprise, trickery, cunning, deception and unfair ways by which one party cheats another party out of financial resources. In order to educate a healthcare manager regarding fraud , many aspects of fraud must be assessed. This includes the types of fraud, the consequences that come with fraud,the individual(s) committing them, techniques to prevent fraud, and why the healthcare industry is vulnerable to fraud.

Welcome to the age of white collar crime. A time when the words thieves and businessmen go hand in hand. White collar criminals don't get their hands dirty in their work. They use their heads to get what they want instead of using a little muscle. These criminals are just as dangerous as the rapists and murderers. In these times, even the most seemingly respectable people are suspected of white collar crimes. President Clinton and the first lady Hillary Clinton have been tangled up in the Whitewater and Travelgate business ventures. Although the two have not been formally charged with any wrongdoing, there is a committee currently investigating their dealings and charges are not out of the question for either of them. In Michael Isikoff's

In this day and age, a corporation, family, or individual always has a potential risk of encountering fraud within their money supply. On average, fraud and abuse costs U.S. organizations more than $400 billion annually (Federal Bureau Investigation, 2010). Many may think that white collared crime is only money laundering or stealing, but that is only two out of the sum that countless culprits get away with. The term “white-collar crime,” originally coined in 1939 is synonymous with the full range of frauds committed by business and government professionals (Federal Bureau Investigation, 2010). These frauds include anything from bankruptcy fraud, money laundering, identity theft, corporate fraud to a wide number of threats all circling