As we head into the next four years under the Obama administration, many Americans are hearing more and more about healthcare reform and what needs to be done to fix the ailing healthcare system. Part of the dramatic increase in healthcare costs is due to Medicare fraud abuse. Healthcare fraud is defined as making false statements or representations of material facts in order to obtain benefits or payment. Healthcare abuse is defined as practices involving the overuse or misuse of services, either accidentally or intentionally, for various reasons that results in overpayment. These acts may be committed by an individual person or an entity. Fraud and abuse exposes a person, provider, or entity to criminal and
The U.S. General Accounting Office estimates that $1 out of every $10 spent for Medicare and Medicaid is lost to fraud. This translates into fewer resources for health care due to the strains on federal and state budgets. During FY 2005, the Federal Government won or negotiated approximately $1.47 HIC, Corp. has an aggressive program to combat fraud and abuse, but need the publics help with reporting problems. Most providers of
Health care is meant to provide medical or psychological care for the entire human population. In order to pay for health care, one must have health insurance or be able to pay out of pocket. However, health care in the United States are nowhere near cheap. In fact, America has the worst healthcare system in the world. America’s health care system is a direct-fee system. A majority of countries around the globe are government controlled. Taxes primarily finance their health care access and delivery. Unfortunately, for America, the US government does not pay for most of its citizens’ health care (Health Care Issues, 2015). America’s health care system is in jeopardy due to increasingly high prices and lack of access.
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
(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
It is easy to see how fraudulent medical billing is having a major impact on the Unites States and the citizens of this country who rely on it on a daily basis. We often hear through the various new sources in this country, on the internet or out of the mouths of politicians and experts in the healthcare field about the failing healthcare system in this country. We often hear many different opinions on what needs to be done to fix our healthcare problem within this country and fix what looks to be a very broken system at this point. No matter what the solution to our poor healthcare system is one thing that is very clear is that healthcare fraud and abuse is playing a major role in the depletion of money in this country and the rise in healthcare costs for the citizens of this country.
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 rising cost of health care has led companies to stop offering health insurance for employees, and private insurance is often too expensive for people to afford. Many families make too much money to qualify for Medicaid, but are unable to pay for private health insurance. Health care costs in the United States have more than doubled in the last twenty years. Insurance premiums are rising five times faster than wages, and Americans are spending more money on health care than people in any other country. The average amount one person pays per year for health care in the United States is 134 times higher than the average of other industrialized countries (“Health Care Issues”). Even people who have insurance aren’t guaranteed coverage. Many insurance companies find loopholes to avoid paying for expensive medical treatment, leaving people with massive debt from medical bills. Medical bills and illness cause over half of all personal bankruptcies in the United
The subject of healthcare in the United States can be a contentious one, and it is also an area where peoples' perceptions don't always align with the facts given by policymakers. What makes healthcare spending so scandalous is the amount of money the United States pours into healthcare each year. Over $8,000 per-patient per-year costs, amount that has more than double any of the other nation. Yet 15 to 25% of the American population has no healthcare coverage due to a lack of any form of universal
There are many methods for executing an inmate on death row and lethal injection is one of them. This method is stated to be a painless injection of different chemicals that eventually stop the heart. unfortunately that has not been the case. Over the years there has been numerous cases were cruel and unusual punishment has been witnessed. Countless of times there have been inmates that have gasped for air, been several punctured wounds with needles trying to find a vein, also clenched their fist in pain. Many people may not see this as a problem but no human being, even criminals, should be like this. Lethal injections shouldn't be conducted if they are not going to be done the proper way. Because of some cases, they changed the way they proceed with lethal injection but to this day inmates are still having complications. With all the complications that have occurred with Lethal Injection, they should banned them from be practiced.
One of this health care’s programs objective is to limit the number of uninsured (Shi & Singh, 2015). This controversial healthcare plan incorporates a privately funded insurance which is paid for through employment and solely by the patient and a publicly funded insurance by the government. Medicare is provided for senior citizens 65 and older, and Medicaid is provided for low income citizens. The federal government and state government both partake in the funding of Medicaid. Although insurance is provided to the low income through Medicaid, the United States continues to suffer from cost escalation spending 17.1 percent of GDP on healthcare in 2013, a 50 percent more than the second nation (Commonwealth, n.d.) The high cost and limited coverage continues to spark up the conversation for a
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
The U.S. healthcare system is broken. The health care expenditures are the highest in the world and increasing every year at a rate that poses a serious threat to all Americans. For example, the national health expenditures per capita increase from $1,110.00 in 1980 to $9,255 in 2013 and it projected to rise to 19.3% by 20251. However, higher spending does not produce better health care or better outcomes and does not improve patient perceptions of the accessibility or quality of healthcare care. We had enough, we cannot rely on our wasteful, fragmented multi-payer system of financing health care; something must be done to improve our healthcare system and make healthcare affordable for the entire nation.
Now that we have looked at the basic facts surrounding this horrific crime, let’s take a look at who is affected and a few different examples of healthcare fraud, to put this all into perspective. Medicaid and Medicare programs began in the 1960’s. While Medicare would constitute the Federal level, Medicaid falls within the state level and are vastly different entities. One article touched on the different areas of Medicaid fraud conducted by physicians. Research has shown that offenders will more than likely offend in multiple areas, instead of focusing on one specific area, to hopefully deter them from being caught (Payne & Grey, 2001). Some of these areas may include one or more of the following areas. First is fee for service reimbursement which is when