Healthcare System The Role Of Finance

In organizing and directing the financial manager decides how to use the resources of the health care agency to best carryout the

Third party – Reimbursement payments made by an insurance company that provides benefits for the

Fraud and abuse encompasses the actions of fraud, abuse, and waste in the health care system (McWay, 2014). It is a nationwide problem that affects all of us and can be committed by anyone. Schemes can be committed by a single person or a by an institution or group. The National Health Care Anti-Fraud Association (NHCAA) estimates that

The FCA provides protection for the Federal Healthcare programs from being cheated for products or services rendered. The FCA impose civil accountability on any individual who intentionally presents, a fraudulent case to the Federal government. For example, a provider submits a claim to Medicaid for a higher caliber of health services than initially rendered in the patient's medical record. A penalty for breach of the FCA can result in fines ranging from $5,0000-15,000 per erroneous case. Under the ACA, overpayment charges under government funded programs must be reported and returned within sixty days of overpayment,

Perhaps the finest total dollar quantity of fraud is devoted via the medical health insurance companies themselves. There are severa research and articles detailing examples of insurance companies deliberately not paying claims and deleting them from their structures,[21] denying and cancelling coverage, and the blatant underpayment to hospitals and physicians beneath what are normal costs for care they provide.[22] Although tough to acquire the records, this fraud via coverage agencies may be anticipated through comparing revenues from premium bills and prices on health

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

Depending on the insurer and the type of service provided, third-party payers pay providers by different means

False claims are a parasite to the American health care system resulting in overall higher health care costs. The Department of Justice reported recovering $1.9 billion dollars in fiscal year 2015 from fraudulent and false claims in health care (Department of Justice, 2015). In 2011, fraud and abuse were estimated to add $98 billion to federal spending for Medicare and Medicaid (Furrow, Greaney, Johnson, Stoltzfus Jost, & Schwartz, 2015). It is the dollar figures like those listed above, that have necessitated the need for the Office of Inspector General [OIG].

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.

The living will is a formal legal document that must be written and signed by the patient, it will describe the type of medical treatment the person would want or would not want in these situations. An attempt to prolong life should be started or stopped. This applies to treatments such as dialysis, tube feedings, or artificial life support. A power of attorney for health care is also called a health care power of attorney. It’s a legal document in which you name a person to be your proxy (agent) to make all your health care decisions if you become unable to do so. Your proxy or agent can speak with doctors and other caregivers on your behalf and make decisions according to directions you gave earlier. The person you chose decides which treatments

There are two fundamental documents which need to be executed during my life to ensure I receive the kind of healthcare I want if I was ever incapacitated. Both the living will and a durable health care power of attorney for health care will allow me to choose someone I trust to make certain medical choices on my behalf. The first is commonly called a living will. A living will allows me to instruct physicians and health care providers about the kind of health care I desire and do not desire if I am unable to tell them myself. The second document sets out who has power of attorney for my health care decisions, with the purpose they may answer questions in which may not be addressed by my living will. A living will and DPOA will give me relief

A third party payer is an organization(s) that reimburses money to physician according to the level of care and treatment that was rendered to the insured member. This payment system represent cost sharing they individuals, about 84.6% of Americans, who elected to pay a set rate in exchange for the access to medical care and service (Buchbinder & Shanks, 2012). Well, the healthcare (HA) system is not longer that simple. The HC system is mandate that legislative and mandates t and most will agree there are that I have HC

United States of America does not have a universal health insurance as in the most industrialized countries. Additionally, USA spends more than industrialized countries on healthcare, but that does not mean that the health of American people is better than populations in the industrialized countries. The health expenditures are 17.1 % of Gross Domestic Product (GDP) in the 2014 (Central Intelligence Agency, 2016). Therefore, healthcare in the US is financed by variety of ways. There are four types of financing for healthcare, which include by government programs, such as Medicare and Medicaid, by Federal government, such as military and veterans, by private health insurance plans, which payment usually

Health care fraud is a serious crime that carries stiff penalties if you are convicted. Estimates show that fraudulent claims cost the government nearly 10 percent of the money disbursed toward health-related costs. Since the cost to handle fraudulent claims are so high, the federal government is cracking down on healthcare fraud and the courts are issuing stiff penalties. Healthcare fraud is not all-inclusive since there are several types of fraud.

However, a will is only useful when a person is on their deathbed and is used to declare your desire to have or not have not have life-saving measures taken if there is a slim chance of recovery. A power of attorney on the other hand covers all health care decisions and lasts only as long as you are incapable of making decisions on your own. It is often a good idea to have both a will and medical power of attorney to ensure every possible situation is