Health Care Fraud and Abuse

Service or System Department of Health & Human Services , 2013). The mission of the Department of Health and Human Services is to help provide the structure that Americans need to live prosperous and healthy lives. This service gives families, children, and seniors a way to receive quality health care. This achieved by helping parents find affordable childcare and legitimate jobs. This organization is dedicated to keeping American’s food safe, preventing infectious diseases, and by pushing the boundaries of how to treat and diagnose disease (U.S. Department of Health & Human Services , 2013).

3.1 Contribute to agreeing roles and responsibilities within a team planning awareness-raising activities/3.2 Work with the team to plan a set of activities to raise awareness about a health issue.

The Office of the Inspector General (OIC) has worked since 1976 to combat fraud and abuse in Medicare, Medicaid, and other Department of Health and Human Service agencies (Week 5 Overview). HHS OIG is the largest inspector general’s office in the Federal Government, with approximately 1,600 dedicated to combating fraud,

management. • Know that your Association is engaged and involved with other leaders in healthcare nationally in efforts

Fraudulent Medical Billing and the Social Impacts It is easy to see how fraudulent medical billing is having a major impact on the Unites States and the citizens of this country who rely on it on a daily basis. We often hear through the various new sources in this country, on the internet or out of the mouths of politicians and experts in the healthcare field about the failing healthcare system in this country. We often hear many different opinions on what needs to be done to fix our healthcare problem within this country and fix what looks to be a very broken system at this point. No matter what the solution to our poor healthcare system is one thing that is very clear is that healthcare fraud and abuse is playing a major role in the depletion of money in this country and the rise in healthcare costs for the citizens of this country.

1. Describe the various missions of the Department of Health and Human Services. The U.S. Department of Health and Human Services (HHS) has the mission of enhancing the health and well being of all Americans. HHS is the U.S. government’s principal agency for protecting the health of Americans and is responsible for providing essential human services for all and especially for those who are least able to help themselves. The Department manages programs that cover all spectrums of activities that impact health care, patient safety, and public health. HHS, though its programs and partnerships, provide health cover to more than 100 million people through Medicare and Medicaid, promote patient safety and health care quality in health care settings, protects vulnerable individuals and communities from poor health treatment, and leverages health information technology to improve the quality of care for all (HHS, 2015). Though it’s programming and other activities, HHS works closely with state, local, and federal agencies to strengthen health care, advance scientific knowledge, advance health care and safety, and ensure transparency, accountability and effectiveness of all HHS programs. HHS’s overall mission is to help American’s live healthy lives by providing millions of children, families, and seniors with access to high quality health care, affordable child care, and by pushing the boundaries of how we diagnose and treat disease.

The United States Department of Health and Human Services information security and privacy program is accountable for ensuring Operating Division SOP participation in the Privacy Impact Assessments (PIAs) process; reviewing completed PIAs, and confirming that they are adequately and accurately completed prior to SAOP approval for web publishing; submitting the Privacy Management portion of the Department’s annual FISMA report to the SAOP for approval (HHS, 2010); overseeing the coordination of privacy-related reporting activities as mandated by federal legislation and OMB guidance; developing the proper policy and guidance for implementation of information privacy protections, including full compliance with federal laws, regulations, and policies relating to information privacy (HHS, 2010); maintaining appropriate documentation regarding compliance with information privacy laws, regulations, and HHS policies; ensuring the Department’s privacy compliance efforts are ongoing, including reviewing documented information privacy procedures to ensure that they are comprehensive and innovative, and managing revision, as necessary; ensure that 100 percent of department employees and contractors receive annual Information Security awareness training and role-based training in compliance with OMB A-130, Federal Information Security Management Act (FISMA), and National Institute of Standards and Technology

The Office of the Inspector General, for the U.S. Department of Health and Human Services is responsible for identifying and combating waste, fraud and abuse in more than one hundred programs such as Medicare. They perform extensive audits and investigations looking for any discrepancies.

Health Care Evaluation Today, many Americans are affected by health care decisions made without their prior knowledge. More than likely most Americans are unsure how those decisions are decided and who is responsible for making those decisions that ultimately affect how health care is administered. The Department of Health and Human Services (HHS) is the United States government’s principle agency for protecting the health of all Americans and for providing essential human services, especially to those who are unable to help themselves. HHS administrators over two hundred programs and it accounts for almost forty percent of all United States federal government spending. HHS mission is to keep Americans safe and healthy through effective health and human service programs. The department has five strategic goals: strengthen health care, advance scientific knowledge and innovation, advance the health, safety, and well-being of the American people, increase efficacy, transparency, and accountability of HHS programs and strengthen the Nation’s health and human service infrastructure and workforce (Department of Health and Human Services, (n.d.).

Why SES oversight is needed: • Oversees the design and implementation of the critical mission essential Air Domain Awareness Architecture the DHS relies on to execute its mission. • Establishes, develops, manages, and evaluates the DHS air domain awareness program and activities to ensure unity of effort. • Directs and oversees the development and implementation

Healthcare Fraud and Abuse As we head into the next four years under the Obama administration, many Americans are hearing more and more about healthcare reform and what needs to be done to fix the ailing healthcare system. Part of the dramatic increase in healthcare costs is due to Medicare fraud abuse. Healthcare fraud is defined as making false statements or representations of material facts in order to obtain benefits or payment. Healthcare abuse is defined as practices involving the overuse or misuse of services, either accidentally or intentionally, for various reasons that results in overpayment. These acts may be committed by an individual person or an entity. Fraud and abuse exposes a person, provider, or entity to criminal and

Running head: HEALTHCARE FRAUD AND ABUSE Healthcare Fraud and Abuse Abstract Rising costs of healthcare is a valid concern for many households in America. A factor in the cost of healthcare insurance is fraud. Fraud is often very difficult to detect. The magnitude of healthcare fraud is unknown. Initial reimbursement and payment and billing timeframe of 90 days allows for fast payment of services, however, many times before there is an indication of fraudulent billing the company has closed up and moved on. Fraud in American healthcare, costs American’s millions perhaps even billions of dollars annually. Without doubt, behind every act of fraud lies a lapse in ethics. This paper will review several pieces of literature to look

Healthcare Fraud, Abuse, and the Impact on the Health Information Professional Healthcare fraud and abuse is a significant hindrance in the United States that is having a negative impact on the individual as well the overall economy. Healthcare fraud and abuse costs the country billions of dollars every year, and ultimately

-In the current position of 3 years as an ombudsman, my role is to examine and evaluate complaints to determine if policy and procedure has been followed and to ensure fairness has been applied by DHS staff based on a complainant’s assertions. Previous to that, I worked for eight and a half years ensuring families received due process as a case worker under the Indian Child Welfare Act when children were involved with the Child Welfare

Another effective way of controlling healthcare fraud and abuse is through reinforcement of federal penalties, enforced by the department of Health and Human Services. For example, in the year 2011, the US department of Health and Human Services committed approximately $248 million in the fight against fraud and abuse. This extraordinary effort resulted in a significant increase in the number of cases prosecuted, amount of money recovered, and the dollar amount of claims filed. The federal government can assist healthcare overall fight the abuse and fraud by being assiduous in prosecuting the providers, the healthcare organizations, and individuals who commit fraud and abuse in an organized and systematic manner, not sparing anyone, because