HEALTHCARE

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HEALTHCARE FRAUD Abuse AND Prevention
Health care fraud is a crime. Fraud is committed when a provider or patient intentionally submits false or misleading information to a health plan for use in determining the amount of health care benefits payable. As a Group Health member, there are steps you can take to prevent health care fraud and to report suspected fraud and abuse. There are a lot of things people can do to prevent Healthcare fraud some things that can be done Start by knowing your benefits and reading your Explanation of Benefits (EOB) statements and any paperwork received from Group Health Cooperative or your health care providers. Be wary of any "free" medical treatment, as these are usually signs.
Rising costs of healthcare
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Attempts to defraud the Medicare program may take a variety of forms. Billing for services or supplies that were not provided Altering claim forms to obtain a higher reimbursement amount deliberately applying for duplicate reimbursement in order to get paid twice Completing Certificates of Medical Necessity which is where the fraud starts in America.
Fraud is a serious crime that should concern all parties of the U.S. health care system and is a costly reality that the government cannot overlook. While not all fraud can be prevented, by learning about the many different types of fraud, patients can be educated on how to protect themselves from fraud. If we use government programs to inform the public that they can be targeted, the dollar amount for these cases for fraud can be reduced. An informed public and a properly funded FBI will go a long ways in the overall crackdown of health care fraud.
The Federal Bureau of Investigation is spending large amounts of its budget to crack down on health care fraud. Special units have been formed to help the FBI Crimes Section find these criminals and take them to court to seek proper punishment. Crimes are being committed by both providers and insurance companies on a daily basis. Moreover, their patients and subscribers are
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