The For White Collar Crime Offenders Within The Health Care System

Committing medical coding fraud or abuse is extremely detrimental to the healthcare industry. They both lead to higher healthcare costs and an increase in the cost needed for medical coverage. In addition, the increasing discovers of these acts are putting a very negative light on healthcare workers, including those who are not committing either act. With the medical world being so complex we often instill and great amount of trust in the persons taking care of medical billing and coding, this trust also makes committing fraud and abuse easier for dishonest people to take advantage of.

Criminals walk amongst us everyday. When people hear the word criminal, “murderer”, “robber”, and “arsonist”, are what most people think of. No one thinks about the CEO of a billion dollar company, the everyday pharmacist, or even a trusted personal financial advisor. This is due to the “respectability” and “high social status” these occupations hold (Temchenko, 2016). Of the many crimes committed every year, white collar crimes are one of the most highest crimes committed because they are overlooked. On July 28, 2016 , 14-year-old Bresha Meadows, who had no prior record of violence, was arrested and potentially up for a life sentence in prison for saving her family from more domestic abuse by shooting her father (Jeltsen, 2016) . In 2003 the former chairman and chief executive of MCSi Michael E. Peppel, who pleaded guilty to conspiracy, money laundering and filing false documents with the Securities and Exchange Commission was only sentenced to spend seven days in prison because Peppel was a “remarkably good man”. The charges against Peppel carry a minimum 8 year sentence (Henning, 2013). Sentencing disparities between white collar crime versus street crime is a crime within itself and some form of justice needs to be served.

Once again, another story of billing fraud in a medical practice made news this past week in Becker’s Hospital Review “Medical practice manager sentenced to prison of billing fraud” on April 6, 2017, by Ayla Ellison.

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.

One of the most critical factors which contribute to the number of preventable cases of healthcare harm is the culture of silence surrounding these cases. The fear of medical providers to report incidences is related to the possibility of punishment and liability due to a medical error (Discovery, 2010). The criminalization of some acts of medical error has resulted in job dismissal, criminal charges and jail time for some healthcare workers. This is despite the fact that the system they are working in helped to create the situation which led to the error in the first place. Human error, due to fatigue and system errors can result in deadly consequences, but by criminalizing the error it effectively shuts down the ability to correct the root problem. Healthcare workers, working at all levels within the medical system, can provide valuable input on how to improve the processes and prevent harm from occurring (Discovery, 2010).

The most not unusual perpetrators of healthcare insurance fraud are fitness care providers. One reason for

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

The purpose of this paper is to bring awareness to the issue of healthcare fraud and abuse. I feel that healthcare fraud and abuse is one of the biggest issues in healthcare. So, this paper will get everyone to be able to spot fraud before it happens. During, the process you will be able to identify what a person organization did that was fraud or how they abused healthcare rules. This paper will explain to you what exactly healthcare fraud and abuse is and how it affects everyone around us. Throughout this paper, we will examine 3 different articles related the healthcare fraud and abuse and provide a summary and analyze them.

Fraud and abuse encompasses the actions of fraud, abuse, and waste in the health care system (McWay, 2014). It is a nationwide problem that affects all of us and can be committed by anyone. Schemes can be committed by a single person or a by an institution or group. The National Health Care Anti-Fraud Association (NHCAA) estimates that

Physicians in several places have a bad reputation due to billing fraud. These acts are committed by individuals and organizations to proceed personal or business advantage. In fact, health care fraud is a type of crime that may be committed by health care providers or companies which provide medical supplies or services, and health care organizations. It is a recent trend to which physicians and their practices are unfortunately doing by organized crime groups in complex health care fraud schemes.

As a child, I always thought all healthcare practitioners such as doctors, nurses, and physicians were real life superheroes. Healthcare practitioners were the kind of people where the needy went to get treatment for any of their ailments. This belief ended June of 2016 when I saw some doctors for who they really were: villains. I fell victim to healthcare fraud, specifically overbilling, which destroyed my belief in the goodness of healthcare practitioners and providers. The rate of healthcare fraud like inflating hospital charges of materials and procedures, false billings, and performing unnecessary medical procedures to create insurance payments have been increasing over the past few years. Nothing good comes out of healthcare fraud and offenders should be stopped immediately.

Fraud in health care is a major issue, even with all these laws and rules on how on to comply. Here are some of my example on overt, covert, and occult fraud inside the health care system.

The crimes that occur in the healthcare setting are; health care identity theft, fraud, falsification of records, misuse and theft of drugs, patient abuse and murder. Healthcare identity theft is when someone or a group of people who hack into medical systems or pay to have someone get private information so that they can then use the information to bill falsely for services not rendered. Fraud according to Pozgar (2014) is:

Healthcare fraud is costly for everybody, as it harms the reputation of the institution or physician committing it, and financially damages the patient being affected.By definition fraud may be defined as intentionally employing surprise, trickery, cunning, deception and unfair ways by which one party cheats another party out of financial resources. In order to educate a healthcare manager regarding fraud , many aspects of fraud must be assessed. This includes the types of fraud, the consequences that come with fraud,the individual(s) committing them, techniques to prevent fraud, and why the healthcare industry is vulnerable to fraud.

“Professional integrity derives its substance from the fundamental goals or mission of the profession” (Wakin, 1996, para. 15). Meaning to say, individuals seek for a professional’s valued and ethical advice to which the professional holds their responsibility to maintain and exceeds the level of their expertise. For example, a general practitioner will treat a variety of patients, from all different walks of life with a plethora of different problems. It is their duty to diagnose and treat the patient to the best of their professional ability without prejudice. Another aspect of their duties is the principle of patient confidentiality. Medical professionals are legally bound to not divulge any information provided to them by their patients.