The Common Types Of Fraud And Abuse

Medical error is the third leading cause of death in the US, right behind heart disease and cancer. More than 200,000 people die annually as a result of diagnostic mistakes and negligence by healthcare professionals (Washingtonpost, 2016). In the healthcare industry, even the smallest mistakes and oversight could lead to severe consequences for both the patient and professionals. A healthcare professional would be held liable for any discrepancies that causes harm. The following case will analyze the ethical issue and negligence that lead to the death of an elderly woman.

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

For the last five years of my life I have worked in the healthcare industry. One of the biggest issues plaguing our nation today has been the ever rising cost of health care. If we don't get costs under control, we risk losing the entire system, as well as potentially crippling our economy. For the sake of our future, we must find a way to lower the cost of health care in this nation.

To any individual, anyone working in the medical field may not seem harmful of being a white collar crime offender. As Edward Sutherland stated, crime can be committed by a person of high social status and respectability in the course of his or her occupation. We the people believe and trust those who work under the medical field because they have education, earn a good living, and ultimately help us when we are sick. We don’t see them as criminals, but the text will focus on why there is a need to pay attention to white collar crime offenders within the health care system. This paper will focus on a case from a doctor who was charged for committing healthcare fraud. This paper will focus on how those who

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

Uninformed verdicts from medical malpractice law suits and the rising cost of medical malpractice insurance are thought to contribute to the high cost of medical care. This is because they force doctors to practice defensive medicine by ordering extra tests and procedures to protect themselves in the event of a lawsuit. The amount spent on these precautions, legal fees, claims, and unlimited damage awards also reflect in the rising cost of medical care which intern is passed down to the patients. Today patients are becoming more litigious because there are many lawyers luring you in, with advertisements geared towards lawsuits for medical malpractice. Most of the time malpractice suits consist of falsified allegations, seen by most people

In healthcare fraud and abuse has become a big problem for the federal government. The government are investigating the rise and providers that are becoming the next to investigate the next target. When it comes to investigate the office of inspector general audits the health care financing administration to reveal errors in percent of claims that was paid by the HCFA in the fiscal year 1996. These errors on the accounts are approximately $23.2 billion annually or the percent of the total Medicare fee for service manage the care of payments. Half of the errors are identified are results from the insufficient or the lack of documentation from providers, and one third of the documentation errors are associated

The case study analysis involves a major news station and their findings, “in October 24, 1999, MSNBC reported online that in a survey taken recently it brought to light that 169 physicians had admitted to lying in order to get care for patients”. Right away, we all felt that this was acceptable, common and almost expected. In this case study, these physicians said, “due to the tendency for insurance companies to deny care, they (the physicians) believed it was medically necessary, they had written false information on charts to get the treatments covered for patients who could not afford the care otherwise." We agreed that there was a need in 1999, today the need is even direr.

Healthcare fraud an abused are a threat to the healthcare environment, because of people an technology use. I have heard on the news an reading articles of how healthcare fraud an abuse is becoming a popular habit. I can see how the constant change in technology can become a threat. I use technology to document patient information and to put my time in when I'm with a patient, an I can see where people can commit fraud an abuse, using technology. A lot times there was incident where the company sent out many emails on employees claiming to providing care to their patients an the service wasn't provided, an using

In Relation to Health Care, Negligence is conducted under the “law of torts” in which involves unintentional harm that is inflicted onto patients which is caused by the carelessness of the health professionals in which these professionals are then held liable for the patient or client is injured (Forrester & Griffiths, 2015). From a health care professional’s perspective, this in other words mean that the professional is unable to provide quality standard of care that any other responsible and sensible individual would in similar situations. There are many different types of unfavourable events that are brought upon from the result of the negligence of health practitioners, including the administration of incorrect medication and doses, procedures

(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

offered at their providers’ office that they may have never received. Healthcare organizations work strictly with health care provides to provide optimum care. Because health care organizations work so thoroughly with primary care practices, it allows health care organizations an insight on how they function. Complications that may contradict the program include falsifying patient signatures to unearned incentives. This termed is widely known as health care fraud, further detailed by study as “the basis of the scheme or artifice to defraud in a mail or wire fraud conviction, including billing for services not rendered, false descriptions of services rendered, and false representations that services were medically necessary” (McGuire,2007).

Clinical Programs strives to reduce unnecessary medical expenses and help improve quality of care by implementing innovative solutions to reduce Fraud, Waste and Abuse. Success is based on collaboration with key business partners and targeted initiatives that reduce pProvider abrasion and promotes evidence based medicine.

Generally $700 billion of the $2.7 trillion spent on medicinal services in the US is owing to misrepresentation, waste, and mishandle. Social insurance payers manage false professionals, sorted out criminal plans,