Medical Identity Fraud

Medicaid Fraud HCS/545 July 9, 2012 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

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

Authority and Role of the Risk Manager Although the discussion focuses on the risk manager, most large health care organizations employ a team of individuals to reduce the risks of loss and increase patient safety from both a proactive and reactive stance. The health care environment is constantly evolving, but nothing has made change as pervasive as the Patient Protection and Affordable Care Act (PPACA) and the regulatory and compliance mandates contained within its wording. For instance, maintaining confidentiality of patient information, a key function of risk management, is now more difficult with the rise of cybercrime of medical information. According to Finkle (2014), the Federal Bureau of Investigation warns health care providers there is high demand for medical information by criminals to commit both impersonation crimes and financial fraud. These concerns were unheard of not long ago. Confidentiality and protection of patient information is only

Running Head: ETHICAL HEALTHCARE Ethical Healthcare Issues Paper Wanda Douglas Health Law and Ethics/HCS 545 October 17, 2011 Nancy Moody Ethical Healthcare Issues Paper In today’s health care industry providing quality patient care and avoiding harm are the foundations of ethical practices. However, many health care professionals are not meeting the guidelines or expectations of the American

Course Project Rough Draft MGH HIPAA violation case Jennifer Brummage Medical Law and Ethics In the health care business, there are certain standards and laws that have been put in place to protect our patients and their personal health information. When a health care facility fails to protect their patient’s confidential information, the US Government may get involved and facilities may be forced to pay huge sums of money in fines, and risk damaging their reputation.

Title II of HIPAA covers two main areas: preventing healthcare fraud and abuse, and a broad series of rules under the framework of administrative simplification. The first area is not of significant interest to most healthcare workers. It defines numerous offenses relating to healthcare, and authorizes several programs to attempt to find and control fraud and abuse. Nurses should be aware of the proper procedures for reporting fraud and abuse at their facility. The second portion of Title II—administrative simplification—however, contains five separate rules, most of which have already had a significant impact on virtually everyone working in American health care, including all those working in any way with health information concerning

Physician and pain clinic owner Paramjit Singh Ajrawat, of Potomac, Maryland has been ordered to repay $3.1 million from a healthcare fraud scheme. He reportedly filed fake insurance claims, according to the U.S. District Attorney's Office in Maryland. In September 2015, a federal jury convicted Ajrawat, his wife, and clinic co-owner Sukhveen Kaur

Identify theft, in general, can affect a person for a lifetime. Federal law defines medical identity theft as “A fraud committed or attempted using the identifying information of another person without authority to obtain medical services or goods, or when someone uses the person’s identity to obtain money by falsifying

HIPAA, otherwise known as the Health Insurance Portability and Accountability Act, was enacted in 1996 which required organizations to devise methods to safeguard transfer and disclosure of personal health information (Shi, 2015). Protected health information (PHI) is any information about a patient’s health status that can be associated to a

As anyone can see, health care fraud is a huge issue in the United States and with the upcoming nationalized health care system finally going into effect this year, more opportunities

Don't Be a Victim of a Health Care Security Breach Don't Be a Victim of a Health Care Security Breach Hospital and health facility administrators face hardened criminals who hack medical records with ever-increasing sophistication. Hackers gain access to critical information, such as medical claims, financial data, Social Security numbers and credit

Introduction There are laws in place that protect a patient in the health care setting. The Health Insurance Portability and Accountability Act of 1996 or HIPAA, as it is known in the healthcare field, was designed to protect the privacy,confidentiality and security of patient information (Pozgar, 2013).Employees the health care field

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 is a US law aimed to advance the portability and continuity of health insurance coverage in both the group and individual markets, and to combat waste, fraud, and abuse in health insurance and health care delivery as well as other purposes26. The Act defines security standards for healthcare information, and it takes into account a number of factors including the technical capabilities of record systems used to maintain health information, the cost of security measures, the need for training personnel, the value of audit trails in computerized record systems, and the needs and capabilities of small healthcare providers. A person who maintains or transmits health information

Coding Fraud/Abuse Committing medical coding fraud or abuse is extremely detrimental to the healthcare industry. They both lead to higher healthcare costs and an increase in the cost needed for medical coverage. In addition, the increasing discovers of these acts are putting a very negative light on healthcare workers, including those who are not committing either act. With the medical world being so complex we often instill and great amount of trust in the persons taking care of medical billing and coding, this trust also makes committing fraud and abuse easier for dishonest people to take advantage of.

Final Assignment Alleged improper admission orders resulting in morphine overdose and death Eghosa Idumwonyi Davenport University HCMG730 June 18, 2015 Introduction The department of Health and Human Services protects and guides the health and well being of individuals here in America (Thacker, 2014). They fulfill these duties providing Americans with adequate and efficient health and human services