Medical Identity Fraud

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.

Some people use patient information illegally. They could get their name, address, social security number, or credit card information if they have used it to pay their bill. If that happens they someone could easily run up their credit card bill and buy things they want. Then have the bill sent to the patient and before they figure it out they have already maxed out their credit cards while the patient

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

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.

Physician and pain clinic owner Paramjit Singh Ajrawat, of Potomac, Maryland has been ordered to

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

In most offices, and outpatient services has a team where the physician is unable to monitor the team at all times. For example, in a pharmacy setting there are pharmacists, pharmacy technicians, and clerks at times. The majority of the time the clerks have the most patient contact where the pharmacists are unable to monitor them at all times making sure protected health information is not spread. In the HIPAA rules, covered entities include health plans, health care clearinghouses, and health care professionals who electronically transmit any health information in connection with transactions for which HHS has adopted standards (Tomes, 2007). In writing, the people who are liable for violations are one those providers who bill electronically are covered entities. Directors or officers can commit violations by selling individually identifiable health information to a drug company for marketing purposes, they can also be charged if the director and or officer aided a covered entity’s commission of the HIPAA criminal act, and lastly can be heavily prosecuted if they commit identity theft utilizing patients protected health information (Tomes,

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

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 are very aware of HIPAA and the rights of their patients. All staff knows that patient information can only be discussed with qualified individuals on a need to know basis. Speaking about cases outside of work is strictly prohibited. Photography or recording of any patient interaction is also a breach of a patient's rights as well. The problem with this is that there are many policies in place to protect the

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 College of Healthcare Executives (ACHE) or obeying the organizations code of ethics policies, especially with the use of electronic medical records (EMR). Many patients fear that their personal health information (PHI) will be disclosed by hackers or unauthorized users. According to Carel (2010) “ethical concerns shroud the

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

Physicians in several places have a bad reputation due to billing fraud. These acts are committed by individuals and organizations to proceed personal or business advantage. In fact, health care fraud is a type of crime that may be committed by health care providers or companies which provide medical supplies or services, and health care organizations. It is a recent trend to which physicians and their practices are unfortunately doing by organized crime groups in complex health care fraud schemes.

Healthcare fraud is costly for everybody, as it harms the reputation of the institution or physician committing it, and financially damages the patient being affected.By definition fraud may be defined as intentionally employing surprise, trickery, cunning, deception and unfair ways by which one party cheats another party out of financial resources. In order to educate a healthcare manager regarding fraud , many aspects of fraud must be assessed. This includes the types of fraud, the consequences that come with fraud,the individual(s) committing them, techniques to prevent fraud, and why the healthcare industry is vulnerable to fraud.

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.

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 and monitoring services designed to increase the efficiency of care in the health system (Thacker, 2014). One of the services being monitored by the department of Health and Human Services is the electronic health record system, which carries private and vital information of patient’s health record enabling all eligible participating health workers access to these records (Thacker, 2014). A breach of the protective health information of patients in a health organization creates chaos as these are against the health insurance portability and accountability (HIPAA) law (Thacker, 2014). Hence, measure will have to be put in place to determine what caused the breach and how to rectify it to ensure the breach never happens again (Thacker, 2014).