The healthcare system is a system which allows for fiscal security and health care to all citizens. This well- thought of attemption to improve society sounds very good, and overall has been proven to help people. This system has also created several problems for the United States government. There have been thousands of cases of fraud and abuse to the system along with the increasing of massive debt, rising of taxes, and lack of motivation amongst the people. Currently in America has been using the wellness programs as a way to help and provide for those who cannot for themselves, but now healthcare costs are overtaking our economy in many different ways. The cost and growth of wellness programs across the nation have defiantly risen …show more content…
Throughout the years government healthcare programs have been faced with people trying and sometimes succeeding in scamming the system. Even doctors and nurses have mistreated the system for their own personal power. Some doctors tend to persuade and sell their patients into buying motorized wheelchairs that they do not need to be buying. These doctors receive kickbacks from the companies that sell these wheelchairs. A 2008 report by Senate investigators that they examined were fraudulent. (Edwards and DeHaven, 2) The Government Accountability Office (GAO) says that there are seven-teen billion dollars of improper Medicare payments each year that are fraudulent and pays over to healthcare providers, such as doctors. This means that doctors are getting bigger pay checks by selling fraudulent equipment, medicines, and medical treatments and procures to their naive patients. The GAO puts the cost of Medicaid payments at thirty-three billion dollars of 10.5% on the programs spending. All the fraudulent claims and scams being brought amongst the programs can result for tax payers into paying sixty-three billion dollars. This proves that America’s economy cannot afford to charge their tax payers any higher, or spend any more money on these programs. The federal crimes of fraud and abuse have also increased against the government sponsored healthcare programs. In an article written by Abraham David Benavides and David
Medicare and Medicaid have cause a great deal of damage to the American society. "Years of scandal have shown the waste, fraud and abuse that is rampant in Medicare and Medicaid." (Fallen Guardians of Justice: How the Supreme Court is
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
The documentary “Money and Medicine,” reveals the essentials of unnecessary health care spending and the policies that intervene with the health care systems. In the beginning of the film, the people being interviewed talked about patients receiving major amounts of unnecessary treatment and that a majority of health care spending is devoted to needless services. Several physicians in the video explained the extreme dangers that are present within health care; along with clarifying that they are paid more when doing harm to their patients and when they do more for them even if it is not beneficial to do so. If the cost of health care continues to rise, health care will become too expensive and unavailable that the U.S. will be put in a financial
The healthcare system of the United States was established as a system of health and welfare programs created to provide affordable treatment to the citizens of the United States. Recently, the Affordable Health Care Act was passed changing the structure of the system (Mulvany, 2012). While in theory the new arrangement works, it has its flaws due to the resulting cost, slowness, and the government interfering with religious and personal beliefs. These problems have led many people to question the role of the government in the life of the individual.
Medicare is national government run program that was developed in 1965. Medicare provides health insurance to Americans aged 65 and older who have worked and contributed to the program throughout their whole life by utilizing around 30 private insurance companies. The program also assists in providing benefits for younger people with disabilities. As well as offering Medicare in the United States a program called Medicaid is also available. Which is also a government run program, Medicaid is a state run program that provides hospital and medical coverage for people with low income (Medicare, 2015). With Medicaid being a state run program that allows each state to have different rules and regulations for who is and isn’t eligible as well as if they move across state lines. The programs listed above have helped many Americans over 65 and have a low income to be able to afford healthcare and receive the proper services for their healthcare concerns and issues. With any program and especially a government program there are going to be people who use and abuse the process which leads to Medicare and Medicaid fraud. There are many forms of fraud in Medicare and Medicaid such as billing for equipment or services that weren’t needed, falsifying health issues, dispensing generic prescriptions but billing for name brand. With there being so many types of fraud and investigations happening more and more due to the fraud that is occurring, people are finding more and more ways to
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
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
Health care systems are made to improve and provide quality, efficient care, work in a more collective fashion to improve patient care and reduce overall healthcare cost. They must be mindful of wasteful spending and become more accountable to a diverse patient population.
The U.S. health care system consumes a huge amount of the U.S. Gross Domestic Product, and is a massive system that provides essential and world-class care to millions of people (Niles, 2016). As a result of this huge burden of cost associated with it, the U.S. healthcare system has been critiqued, and has played a major role in sparking debates about changes to the way the U.S. healthcare system is run and organized. Thus, healthcare has been on the forefront of many American and politician minds over the last decade and beyond, and many proposals and attempts have been made to change and adapt the complex and influential U.S. healthcare system. One such attempt, that brought about incredibly influential change to the U.S. healthcare
In 1965, as part of his Great Society Legislation, President Johnson signed Medicare and Medicaid into law. With these two programs he concluded two decades of congressional debate of the future of health care. In the forty years to follow, the United States of America and its health care industry experienced dramatic changes. Population increased by over one hundred million people (Census Bureau), advances in medical technology supported a growing elderly population, diets and lifestyle habits changed, and health care costs outpaced both per capita GDP and wages. By 2010, America was long overdue for health care reform. That year, President Obama passed the Affordable Care Act (also the ACA or Obamacare), an ambitious plan of over 400 provisions for one of the nation’s most complex and powerful industries—an industry upon which millions of lives depend. The Affordable Care Act of 2010 fails to fully address the fundamental problems with American health care system, but serves a necessary and promising starting point for such comprehensive reform.
The concept is built on trade-offs meaning that one aspect cannot be affected without affecting the other two. The most common view of this problem is that each aspect is in direct competition with the others. Analyzing Medicare in relation to The Iron Triangle, consumers who participate in the healthcare system through Medicare must still pay deductibles, fees and other costs not covered by the program. Additionally, enrollees who choose non-hospital coverage or Part B will have to pay a premium. In 1993, up to 11% of Medicare participants were also enrolled in Medicaid programs which pay expenses for the poor who may qualify for the benefits. Approximately 75% of Medicare enrollees have some form of health insurance coverage (Gok & Rubin p.1520). Younger participants don’t seem to fare as well within Medicare since the program focuses predominantly on people 65 and over. Too often, the role that Medicare plays in the younger population with disabilities is overlooked. A Kaiser Family Foundation survey drawn from administrative data provided by Centers for Medicare and Medicaid Services (CMS) found that non-elderly disabled beneficiaries reported problems with healthcare access and cost. Opinions have varied on the success and failures of Medicare in relation to overall access and cost. “According to (CMM) Centers for Medicare and Medicaid Services, total healthcare expenditures exceeded $2.1 trillion or more than $7000 for every American man, woman, and child” (Kuttner p.549). Total healthcare spending in 2006 was 16% of the GDP and was projected to reach 20% by 2013. The phenomenon known as “medical inflation” is believed to have contributed to rising costs of healthcare. An aging population, technology advancement, litigation, defensive medicine and insurance coverage that favors high taxes. The most common
New government statistics show federal health care fraud prosecutions in the first eight months of 2011 are on pace to rise 85% over last year due in large part to ramped-up enforcement efforts under the Obama administration. The statistics, released by the non-partisan Transactional Records Access Clearinghouse, show 903 prosecutions so far this year. That's a 24% increase over the total for all of fiscal year 2010, when 731 people were prosecuted for health fraud through federal agencies across the country. Prosecutions have gone up 71% from five years ago, according to TRAC. (Kelly Kennedy
(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
US health care expenditures have been rising quickly over the past few years; it has risen more than the national financial system. Nonetheless a number of citizens in the US still lack appropriate health care. If the truth be told, health care expenditures are going to continue to increase; in addition numerous individuals will possibly have to make difficult choices pertaining to their health care. Our health system has grave problems that require reform, through reforming, there is optimism that there will be an increase in affordable health care and high-quality of care for America. Medicaid, Medicare and private sector insurances are all going through trials and tribulations because of