The Common Types Of Fraud And Abuse

2047 Words Jun 19th, 2015 9 Pages
In today’s society more and more individuals are being the affected by fraud and abuse by healthcare in both direct and indirect manners. Fraud is known and defined as a deceptions that is knowingly caused, erroneous statements, and misinterpretation made by an individual with the intent to deceive another person in order to benefit oneself of another individual. Abuse is known as practices that are inconsistent with the standards of care given by professionals, the truth behind the term medical necessity or sound medical practices. Intent is the major distinction between the terms fraud and abuse. Both fraud and abuse can be committed by a variety of individuals including insurance companies, physicians, and even patients.
The most common types of fraud and abuse seen in healthcare occur in billing for services that have not been performed, or overbilling for services that have been provided, and most disturbingly, misdiagnosing medical conditions to prevent incurring the financial responsibility for the proper treatment of illnesses or diseases. A variety of individuals within our population can be affected when fraud and/or abuse occurs.
Decreasing the amount of fraud and abuse that we see in society will not be easy but it is possible. In order to do this the healthcare industry needs to consider a few key ideas. What actions need to be taken to decrease the seemingly high costs of health insurance premiums and copayments? Who ultimately pays the bill when…

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