The Common Types Of Health Care Fraud

Dictionary has explained that an abuse is the misuse of words and corrupt practice i.e bad practice in short. Google describe abuse in two ways

If at any point that the provider knows or should have known that a submitted claim was false, then the attempt to collect unearned money constitutes as a violation for the improper claim filed. Id. Examples of improper claims include; billing for

There are several types of abuse. All of which can be enacted by a health care worker, family, and caregivers. Abuse is defined by physical, psychological, medical, financial, and sexual abuse (Pozgar, 2013). Patient abuse can affect all ages, but as stated earlier, the vulnerable

Some estimate that the federal government loses 30 percent of every dollar it spends on medical claims, due to medical billing mistakes and fraud. With so many loopholes and regulations surrounding Medicare, it is impossible for one person to know every nuance. However, constant diligence and ethical practices are a cornerstone of catching and preventing medical billing mistakes.

Healthcare fraud and abuse are different terms that describe different types of deceitful acts done by healthcare professionals or by solo individuals. Fraudulent medical billing is defined as knowingly submitting false statements or making misrepresentations of facts or false documentation to obtain a health care payment. These payments for which no entitlement would otherwise exist, knowingly soliciting, paying, and/or accepting compensation to encourage or reward referrals for items or services reimbursed by federal health care programs and making prohibited referrals for certain designated health services. Fraud healthcare schemes include

The law has found that abuse is a major problem. Their have been several acts that have

Yet, with all of this positive marketing for new surgical procedures, the lack of knowledge of potential patients is being taken advantage of on a routine basis. Hospital administrators are now trying to find more ways to get their physicians to get more work in order to add to the hospital's bottom line. Physicians are feeling the pressure from management to get as much work done as possible and they are burning themselves out (Health Care Fraud 1).

Physical abuse: Physical abuse is when an individual is being physically harmed by the people who are responsible for their care

Restitution is another factor when convicting these criminals. Criminals convicted of healthcare fraud can pay restitution from hundreds, to multiple thousands of dollars, depending on the crime committed and the money improperly obtained as a result of their criminal behavior. Probation is another punishment that the judge may impose on the offender. Probation will limit the offender’s freedom, once released from the criminal justice system. Probation lasts at least twelve months (Criminal Defense Lawyer, 2017). As stated earlier, healthcare crimes can be something small or on the larger scale, but in the end, the result is the same, it is illegal and it will be punished, as has been shown here.

Herein, the violations of law governing Medicare, the possible penalties faced and by whom in this office, recommended actions for Sam to take, and safeguards the office may consider putting in place to prevent this from happening in the future in this specific case will be reviewed.

Healthcare fraud is a deliberate misrepresentation, deception, or intentional act of deceit for the purpose of receiving greater reimbursement thus harming the healthcare industry. Healthcare abuse is wrongdoing with disregard and reckless conduct that goes against acceptable business and / or medical practices resulting in greater reimbursement.

People can be affected by healthcare fraud and abuse directly and indirectly. Fraud is defined as an intentional deception, false statement or misrepresentation made by a person with the knowledge that the deception could result in unauthorized benefit to oneself or another person. It includes any act that constitutes fraud under applicable federal or state law. Abuse is defined as practices that are inconsistent with professional standards of care; medical necessity; or sound fiscal, business, or medical practices. Intent is the key distinction between Fraud and Abuse. An

Even in medical school, future doctors are groomed to perpetuate this cycle of abuse, and when they go on to start their own practices, their anger and frustration are often taken out on the very people they are supposed to be there to help; their patients.

A second example, resulted in the lawsuits of local hospitals in Los Angeles County (Glendale Adventist Medical Center, Pacifica Hospital of the Valley and Beverly Community Hospital Association) being accused of “patient dumping.” In this lawsuit, it was found that mentally

Enacted in 1998, this act prevents patient dumping. By dumping it means preventing emergency rooms from refusing treatment or transfers to patients because of the patient’s inability to pay for the cost. One example of the protection of this act is protecting patients from receiving the appropriate medical care, and restricting the emergency room staff from discussing the patient’s financial status. Another example is patients diagnosed with an emergency must be treated and discharged or admitted to another emergency department under the protection of the act.