Life & Health Insurance Fraud

Medicaid fraud comes in many forms. A provider who bills Medicaid for services that he or she does not provide is committing fraud. Overstating the level of care provided to patients and altering patient records to conceal the deception is fraud. Recipients also commit fraud by failing to report or misrepresenting income, household members, residence, or private health insurance. Facilities have also been known to commit Medicaid fraud through false billing. The Medicare and Medicaid fraud and abuse statute provides that an individual who knowingly and willfully offers, pays, solicits, or receives any remuneration in exchange for referring an individual for the furnishing of any item or service

Throughout most sources, though, it is clear to see that employer fraud is the most prevalent and costly type of fraud. Employer fraud includes a number of schemes used by employers to reduce the number of workers' compensation insurance premiums by underreporting payroll, misclassifying employees' occupations and misrepresenting their claims experience. According to the National Council on Compensation, the most common frauds include:

Medicare and Medicaid fraud has some strengths as well as weaknesses. A strength that comes with healthcare fraud is The Affordable Care Act. This act helps to fight health care fraud, abuse and waste (Department of Human Services, 2014). Many laws have been implemented to help commit those people that have been committing Medicare and Medicaid fraud. Per the Center of Medicare and Medicaid services website “The Affordable Care Act increases the federal sentencing guidelines for health care fraud offenses by 20-50% for crimes that involve more than $1 million in losses, establishes penalties for obstructing a fraud investigation and makes it easier for the government to recapture any funds acquired through fraudulent practices” (Department

Medicare fraud is becoming a huge problem in today’s society. Medicare is a health insurance program for personnel paid by taxes the American population contributes to for personnel 65 years or older. When a health care provider, health suppliers, and private health companies deliberately bill Medicare for supplies or services that were not given is considered Medicare Fraud. To include, when a person uses another person’s Medicare card to receive health care for which the person does not qualify for. An individual, company, or a group can commit a Medicare fraud scheme.

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.

What is Medicare fraud? ("F&A," 2011, p. 1) states “Medicare fraud happens when Medicare is billed for services or supplies you never got. Medicare fraud costs Medicare a lot of money each year.” What is Medicare abuse? ("F&A," 2011, p. 1) defines this as “Abuse occurs when doctors or suppliers don’t follow good medical practices, resulting in unnecessary costs to Medicare, improper payment, or services that aren’t medically necessary.”

What is healthcare fraud? Healthcare fraud is a criminal behavior, in which a person files a false claim, with the purpose of reimbursement. Healthcare abuse is similar, but focuses more on practices that do not match up with accepted solid financial, business, or medical practices, thus resulting in an avoidable cost or repayment for services that are not needed, or that fail to meet professionally familiar values for healthcare (Johns Hopkins, n.d.). While these both may have very different definitions, they are fall under the category of healthcare fraud and are both punishable by law when convicted. Healthcare fraud may be something as simple as a doctor over billing the insurance for only a few dollars, all the way on up to

I currently work in a nursing and Rehab Facility for Elderly People. Whether it is short term or long term I see a lot of patients file daily. I oversee all their chart filing of insurance claims, SSI, Verification Forms, ID Cards, and Any medical codes that need to match the patients Files. Reading through National Health Care Anti-Fraud Association. (2016) I was shocked to see the amount of fraud that has occurred between 2000 and 2014. When you are going to see your doctor for a physical and you get a physical Exam and this occurs, " medical identity theft victim may unexpectedly fail a physical exam for employment because a disease or condition for which he's never been diagnosed or received treatment has been unknowingly documented in his health record." That is appalling, this patient just now had his job jeopardized,

Medicaid fraud is a concern in the medical world. The problem that medicaid faces is that people on that program are the most vulnerable of all. Many, do not understand what type of treatment they are getting, and don’t question whether they need the treatment or not. Furthermore, medicaid does not send the claims made by the provider to the client, or does not explain the services already paid. The case of “Davis Ethical Pharmacy,” proves the medicaid have a weak point: William Davis(the pharmacist involved in the medicaid fraud), took advantage of that weakness. He stole money from medicaid by “improperly billing,” not only he did it during store hours; but also after the drug store was supposed to be closed. As a patient, I would be concerned

If you are convicted of Social Security fraud, you can be fined up to $10,000, incarcerated for up to 15 years, or both, depending on the law you violated. Keep in mind that you can be prosecuted even if the SSA never made payments to you (in other words, you were denied disability benefits).

Deliberately falsifying medical information with the hope of receiving greater benefits/money is an easier way to describe health care fraud. Although many believe these acts are commonly performed by individuals, healthcare providers, staff, and insurance companies are increasingly involved in these crimes as well. When looking at the effects of healthcare fraud, losing money is not the only substantial threat. According to Health Research Finding.org, patient identity theft is also on the rise due to healthcare organizations offering the lowest cyber security involving private patient information (Quiggle). Although all medical providers, insurance carriers, clearing houses, and any other organizations handling private healthcare information must abide by HIPAA security laws, the use

Timely Home Health Services is under investigation for Medicare Fraud in the amount of over $13.4 million dollars. There are 4 defendants in this case; Okoroji, Ewah, Nwanguma, and Ogwuegbu. The allegations, that have been brought forth, are that between the years of 2007 and 2015, services for home health care were ordered with falsified documents. Once they sent the record to the provider, who ordered home health under the assumption the documents were correct, Timely sent in the claims for home health care for the patient. All 4 are indicted for conspiracy to commit healthcare fraud. Other counts are that Okoroji and Ewah are indicted on 5 counts, Ogwuegbu 4 counts, and Nwanguma 3 counts of healthcare fraud. The case was brought by

We should focus on treatment, not punishment… OIG report suggests prescribers are not checking the databases, or databases lack current data. What’s their training?

25.7% of Nebraskan veterans reported a VA service-connected disability in 2013. Our article was about Veterans Affairs (VA) and disability fraud. We have summarized our article, connected it to something in our textbook, and discussed a related article. We have also given our opinions on the significance, the impact on the company, and the lessons learned.

Life insurance or life assurance is a contract between the policy owner and the insurer, where the insurer agrees to pay a designated beneficiary a sum of money upon the occurrence of the insured individual's or individuals' death or other event, such as terminal illness or critical illness. In return, the policy owner agrees to pay a stipulated amount at regular intervals or in lump sums. There may be designs in some countries where bills and death expenses plus catering for after funeral expenses should be included in Policy Premium. In the United States, the predominant form simply specifies a lump sum to be paid on the insured's demise.