Health Care Fraud and Abuse

The goal of the Office of the Inspector General is to provide independent and effective oversight of the Los Angeles Police Department and to ensure that the LAPD and its employees treat the public with transparency and respect. The OIG supports the Los Angeles Police Commission by being their “eyes and ears”. They also work with the community to educate them about the Los Angeles Police Commission, the LAPD and the OIG. The OIG uses three sections to make sure Los Angeles police personnel treat the public in a respectful and professional manner; they are Complaints and Audits, Use of Force and Special Investigations and Compliance sections (oig.lacity.org).

Work with the team to plan a set of activities to raise awareness about a health issue.

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).

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, waste and abuse and to improving the efficiency of HHS programs (OIG.HHS. Gov). The organization utilized several other agency units that help make up the HHS OIG agency. Each department is an entity in itself that serves an agreement in the protection providing health insurance, promote public health, protect the safety of food and drugs, and provide funds for medical research and much more.

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

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.

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.

Medicaid fraud is illegal, but it is still big business. According to the Office Of Management and Budget, Medicare made nearly $47.8 billion improper payments in 2010. This is nearly 10 percent of the $528 billion spent on Medicare. The United States cannot afford to keep dealing with this type of fraud.

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.

The office of special population’s duties involves helping the division focus on health conditions specific to specific genders, ethnicity, race and disabilities. Social areas as well as education and age may have may contribute to inequalities. The Office of Legislation, Policy and International Activities is responsible for working with Congress and public regarding issues about health policy on aging. They work closely with advocacy groups, healthcare providers and the public in general. This arear also works with international researchers and scientists to collaborate findings, studies and possible treatments for age related conditions. The international activities are overseen by the office of Deputy Director. Age. The Office of Communications and Public Liaison ensures that the general public as well as healthcare providers and scientists are informed of research findings. The Office of the Planning, Analysis and Evaluation and. on the latest this agency focuses on the understanding of the dynamics of aging and how they interact with the environment and lifestyle factors of individuals.” The Office of administrative management oversees and manages five branches. The five branches are the Administrative management branch that takes care of all the administrative work required for the organization to continue to operate. Some of these support services, procurement, travel,

Medicaid fraud, regardless of who perpetrates the fraud, is misrepresenting information to obtain a benefit from Medicaid. Both the state and federal government have programs to identify and prosecute Medicaid fraud, although, currently, the emphasis is on fraud prevention. Because fraud cost the Medicaid billions of dollars each year, these programs have become sophisticated; New York routinely checks DMV records, bank accounts and other data to discover potential fraud. Whistleblowers also receive money for reporting Medicaid fraud. Everyone who participates, in any way, in the Medicaid program may be charged with fraud including:

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.).

The purpose of this paper is to bring awareness to the issue of healthcare fraud and abuse. I feel that healthcare fraud and abuse is one of the biggest issues in healthcare. So, this paper will get everyone to be able to spot fraud before it happens. During, the process you will be able to identify what a person organization did that was fraud or how they abused healthcare rules. This paper will explain to you what exactly healthcare fraud and abuse is and how it affects everyone around us. Throughout this paper, we will examine 3 different articles related the healthcare fraud and abuse and provide a summary and analyze them.

This booklet is designed to serve as a guidance to concepts of fraud and abuse laws which affect the coding, claims management, charge master and bill reconciliation. It is important to understand the laws as a variety of health care providers’ payment and arrangement activities are prone to fraud which eventually result in criminal penalties and unethical behaviors in health services. To evade associated liabilities, employees should understand the fraud and abuse laws and compliance policies.

Establishes, develops, manages, and evaluates the DHS air domain awareness program and activities to ensure unity of effort.