Essay On Health Care Fraud

In the news recent was the Miami physician pleads guilty for role in $20 Million health care fraud scheme (Justice. Gov). The FBI and HHS-OIG investigated the case, which was brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office of the Southern District of Florida (Justice.

Collectively, the Department of Health and Human Services and the Department of Justice work to reduce healthcare fraud and investigate dishonest providers and suppliers. The Health Care Fraud Prevention and Enforcement Action Team recouped almost 3 billion in fraud, this year alone. Also, aggressive strategies exist to eliminate Medicare prescription fraud. Patients abusing or selling painkillers received by visiting several doctors and obtaining multiple prescriptions costs Medicare millions annually. Fraud affects everyone, preventing it requires government officials and citizens diligently working together.

The members pressed for the administration’s reasoning for allocating funds based on the Affordable Care Act, which gave no direct authority for the appropriation. The provision for funding for the 2014 appropriation of the program was requested, but in the following year it was taken out at the request of the administration.

Fraud and waste of resources allocated for Medicare pose major risks to the program. Medicare is very vulnerable to a number of frauds majorly due to the fact that the program is hardly audited. Medicare scams occur in various ways that include phantom billing where healthcare providers demand money from Medicare for services not offered. The other form of fraud happens in the shape of patient billing where the patients collude with scammers to claim for kickbacks for false medical treatments. The last type of fraud is the upcoding scheme and unbundling, where bills are inflated by claiming that a patient needs more valuable services or procedures than the existing. The government has been sensitizing the general public on the need to avoid such frauds by not disclosing their Medicare card details to

Medicare fraud investigations, if wrongdoing is found, may result in a civil lawsuit or a criminal case. Anyone who receives a letter or a visit announcing that they are under investigation should consult an attorney specializing Medicaid fraud

The typically overlooked crime of healthcare fraud has resulted in a significant monetary loss on the part of the American public paying into government run medical programs, as well as private insurance company programs. Historically, we have seen that in any instance where money is involved people have found ways to or at least have attempted to obtain it illegally. Some do it through overt acts of violence such as a robbery. Others choose more covert ways of illegally obtaining money. This is usually conducted through fraudulent activities. This is the nature of white-collar crime. There is no force or violence involved but it is still illegal. (SSA) Obviously, when such a large amount of money is involved there is

Although Congress has used several anti-fraud measures to protect the federal government health care programs, the False Claims Act of 1986 has become the main weapon that government prosecutors use against perpetrators of health care fraud. Designed to prevent fraud and other abuses in federal government programs, the False Claims Act has been the primary statute the government has used in its fight against health care fraud. However, government prosecutors do not rely on one statute in their prosecution of alleged cases of health care fraud. Instead, they rely on a combination of statutes, but the False Claims Act has emerged as the main statutory weapon.

Qui Tam is a part of the false claim act devised in 1986, which allows people to file suits against other parties on behalf of the USA as a mode of recovering money lost via fraud (Kazmier, 2008). Using the Qui Tam, anyone can aptly file cases against other parties that embezzle government funds. This provision allows those people who file suits as whistleblowers to recover the misused funds (Ruhnka & Boerstler, 2000). Whistleblowers are a pertinent factor in presenting attention to the federal government regarding fraud issues within the health care affiliations in which they work.

The reality is that healthcare fraud negatively impacts everyone in the nation. "Health care identity theft dominated all other crimes in the sector last year, according to Louis Saccoccio, executive director of the National Health Care Anti-Fraud Association (NHCAA), an advocacy group whose members include insurers, law enforcement and regulatory agencies" (Kavilanz, 2010). Groups of organized criminals are hacking into the digital databases of healthcare organizations so that they can take money from the Medicare system, which means that the government is actually the sole largest victim of health care fraud, according to the FBI (Kavilanz, 2010). The scope and vastness of such crimes truly impact everyone. The money that is stolen not only undermines the integrity of the healthcare system as whole, but is taken away from organizations and individuals who truly need it to help people fight fatal diseases, to help them overcome chronic conditions, to put them back to work and reunite them with their families. Fraudulent activity not only compromises the integrity of the entire healthcare system, but takes numerous victims, impairing the healthcare system from accomplishing the full extent of their goals.

The FBI estimates that annually the financial burdens related to healthcare fraud total in the tens of billions of dollars for the US economy. In 2014 alone, healthcare fraud totals outpaced inflation related costs and accounted for more than $3 trillion (Rooting out Health Care Fraud is Central to the Well-Being of Both our Citizens and the Overall Economy, n.d.). To expand upon the various laws which were cited in the article published by the HHS, these laws individually aid greatly in the deterrence of healthcare fraud large in part to their intended purposes. For example, the False Claims Act (FCA) protects the government from being knowingly overcharged for a good or service, the Anti-Kickback Statute (AKS) makes it unlawful to knowingly

Billing for services not rendered, or medications charged to insurance companies but clearly not given is evident. Since the patients Nicole cares for are children and adolescents, they are not able to fully protect themselves due to lack of maturity or knowledge on the subject. Being aware of this vulnerability, Nicole preyed on these victims with the certainty that these patients would have no idea. Health care fraud “displays a reckless indifference to the safety of the American people and constitutes a clear abuse of the public trust, showing a blatant disregard for systems and laws designed to protect public health (p. 210).” These children and families placed their trust in Nicole, who had a duty to care for them, and this duty was undoubtedly

As we become prepared to work in a medical office field,we have to keep in mind so many fraud and unworthy act of health insurance claims out there. Everyday we see on the news how people be under investigation for fraud,and mostly the doctors,physicians know the rules but yet still do wrong. I think as we get prepared to work out there in this field, we should be very careful, and if we witness a fraud about to be happened, we should report it. It is not fair for others to be over billed or whatever the cause might be. Many fraud cases include stealing patients identities. Since its actually our job to actually ask them for personal information.Some examples of fraud are: Home health visits, they are more hard to prove or dissaprove in court.Over

In the decade following entry of TADA, reports of data fraud exploitations to the FTC surged. In 2001, customers documented 86,212 protestations. After three years, the number announced expanded about 250% to 214,905 grievances (FTC, 2007). Information from other government offices and private associations likewise bolster the claim that data fraud has risen exponentially since 1998. The Social Security Administration's (SSA) Fraud Hotline got roughly 65,000 reports of government disability number abuse in 2001, more than a fivefold increment from around 11,000 of every 1998 (U.S. Department of Justice, 2000). The Privacy and American Business (P&AB) study report that the rate of wholesale fraud relatively multiplied from 2001 to 2002 (Morris

Insurance companies and the federal government should pool resources using a percentage of profits to finance a task force to arrestively fight fraud. The penalty for fraud should be more stringent which will cause perpetrators to think twice before formulating a plan to commit fraud. The Affordable Health Care Act is the beginning of many programs established to fight against fraud. Health care fraud is a growing problem and should be taken more seriously by citizens of the United States. Physicians, health care workers, and patients are responsible for

Generally $700 billion of the $2.7 trillion spent on medicinal services in the US is owing to misrepresentation, waste, and mishandle. Social insurance payers manage false professionals, sorted out criminal plans,