Medical Fraud And The United States

Health care fraud and abuse are one of the U.S healthcare system biggest problems, which affect everyone either directly or indirectly. Billions of dollars have been lost due to health care fraud and abuse. With a number of losses, this can lead to increase in health care costs and potential increased of coverage.

Health care fraud and abuse is a significant contributor to high health care spending, resulting in the wasteful spending of health care dollars. The Federal Bureau of Investigation (FBI) and National Health Care Anti-Fraud Association (NHCAA) estimates that 3 to 10 percent of health care dollars are lost to fraud and abuse (Federal Bureau of Investigation, 2010). Fraud is the intentional deception or misrepresentation that an individual knows to be false or does not believe to be true and makes, knowing that the deception could result in some unauthorized benefit to themselves or some other person (Ryan, 2006). Bloomberg reports health care expenditures are rising faster than the rate of inflation and spending in the US has nearly doubled in the last decade and one-half of health care

Healthcare fraud and abuse are substantial influence related to increasing health care cost. In the face of the seriousness of fraud and abuse offenses, increasing numbers of healthcare providers is pursuing new and more lucrative procedures to build business relationships. In the aspect of following an unsafe practice in order to receive kickback is uncalled for and serves as further investigation is necessary. OIG ‘s mission is to protect the integrity of the HHS programs and the health and welfare of the people

According to the Federal Bureau of Investigation (FBI) “health care fraud costs the country an estimated $80 billion dollars a year” ("Health Care Fraud," n.d., p. 1). Because health care costs continue to rise more rapidly than the rate of inflation the threat of health care fraud continues to rise. The Affordable Health Care Act has put new policies in place to identify and stop health care fraud. The FBI along with other government, insurance, and public agencies have joined together to combat fraud at every level. New rules in identifying, investigating, and prosecuting fraud before payments are made to medical providers could save billions of

The addition of the Affordable Care Act (ACA) has helped the CMS narrow down and shut down fraud. The government has new regulations of requirements for providers and what providers can participate under the ACA (Martin, 2015). There is additional screening for providers such as unscheduled visits, fingerprinting, background check, application fees, license checks, and most importantly they are now required face to face with patients before home health services. The government can suspend payments to providers under investigation. In addition, they can temporarily stop admission of new providers in the country when waste, fraud, and abuse are assumed

As the Chief Nursing Officer of the state’s largest Obstetric Health Care Center, this author is responsible for complaints regarding fraudulent behavior in the center. The purpose of this report is to (1) evaluate how the Healthcare Qui tam affects health care organizations, (2) provide four examples of Qui Tam cases that exist in a variety of health care organizations, (3) devise a procedure for admission into a health care facility that upholds the law about the required number of Medicare and Medicaid referrals, (4) recommend a corporate integrity program that will

(Jones and Jing) Though citizens might not see the effects of health care fraud directly, everyone is impacted in one way or another either through increased taxes, high insurance costs, or the inability to afford health care coverage. While we all hear about major frauds in the system, a majority of the frauds are small and usually go through undetected, unreported, or seriously underreported. (Sparrow) These small frauds add up to be a huge problem. There is a large spectrum of frauds in the health-care systems ranging from the theft of a wheelchair, to organized crime groups that steal patient information and bill for phantom services in multimillion-dollar schemes. (Jones and Jing) In many cases, the fraud is minor but all the small scams add up to an enormous loss to the public. For example, the frequent occurrences of forging of a doctor’s signature on a prescription accounts for billions of dollars lost each year. (Jones and Jing) One of the most common crimes involves billing for services that were never performed. This involves a health care provider submitting a false claim to be paid for a patient that was never treated or adding on services to a patient. For example a doctor may obtain names of other people such as a patients spouse or child who are covered by insurance and put in a claim for them as well as the actual patient. (FBI) Another common fraudulent activity involves upcoding of services. This is when a healthcare

Healthcare fraud and abuse in 2014 was costing Americans billions of dollars each year. Healthcare fraud intentions was to deceive a company into paying for services that in most case was not provided or should not been provided. Majority of the ones breaking the law are as follows physicians, patients,laboratories and some hospitals.

The lion's share of social insurance misrepresentation is submitted by a little minority of exploitative medicinal services suppliers. Unfortunately, the activities of these misleading few eventually serve to sully

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

Healthcare services have been on the rise for over 10 years now. According to a 2012 consumer alert, the industry provided $2.26 trillion in payments for more than four billion health insurance benefit claims in the year 2011(Fraud in Health Care). The bulk of the claims and the mainstream of fraud and abuse stem from the Medicare system professionals, who are knowledgeable about the process and persuade new clients into handing over their pertinent information in hopes of deception and illegitimate claims. Multiple and double billing, fraudulent prescriptions, are some of the major flaws in this organization that has made the healthcare services industry curdle. (AGHAEGBUNA, 2011) This is a non-violet crime and is often committed by very

Addressing medical fraud, abuse and waste are the part of improving the healthcare system. In order to prevent these issues in the health care system, patient involvement is most important, they should know their benefits and should always receive the benefit statements. Special monitoring should be conducted to detect the evidence of fraud, abuse and waste and strong punishment should be given to discourage others repeating the similar actions.

According to the legal dictionary, "health care fraud is a type of fraud that involves the use of our health care systems by an individual, medical provider, insurance company in a dishonest manner to profit from it" (Health Fraud). Fraud includes single groups of people, employers and government supplying false information, claim services or documentation that was never provided, changing patient or doctors signatures or changing medical records to establish misrepresented services, and even submitting a request twice. While health care fraud may not be a label as everyday crime people and business touches, hurt and even destroyed by this act. This crime has caused an insurance premium to skyrocket for individuals, small companies, and corporations

I believe health care fraud and abuse has definitely decreased since technology has changed and upgraded. Not only has it prevented fraud and abuse but it has also protected many people's healthcare information a lot more confidential. Most people actually trust technology more than actual files that are kept in a healthcare facility. Technology is always going to change and upgrade because it is all about trial and error. If something is working, in order to prevent or decrease the amount of fraud and abuse that people have been doing you need to test out the technology to know if it works or not. And by the looks of it, it seems like all the fraud and abuse has decreased a lot more than before the technology was started.

These crooks are the possible cause of ruining the reputation of the most trusted and appreciated professionals of our society – physicians. Healthcare fraud can be committed in a variety of ways, but three of the most widely used are described below. The first and most widely known, is billing services that were never endured by using general patient information. When giving personal information out, many hand it over to the front desk assistant at the local doctor. These appear to be people are some of the most known to scam the information and bill patient’s payments that never took place. Keep in mind that when handing over information, the handler is a trusted individual with a good reputation. On the other hand, many are scammed for the opposite; otherwise known as “upcoding,” where patients are billed more expensive services that were actually done. In fact, according to USA.gov a new study showed that 7 percent of identity fraud victims this year reported identity thieves stole their health insurance information, rising up from just 3 percent last year (Federal Bureau Investigation, 2010). This includes the latest scam, called “unbundling,” where scammers con bills and bill each step of a procedure as if it were a separate making the individual pay even more money, leaving devastating effects for the victim. All of which have a common goal of making taxpayers, insurance companies, and