Health Care Fraud I. Introduction 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 …show more content…
Guerrero assigned a staff member who provided a drug education class to his patients, and then billed claims for fifteen to thirty minute counseling sessions, when the staff member giving these classes was not a licensed counselor. Unfortunately, the article does not state how long, if any time, will be spent in prison for the killings of the five individuals. The article does not provide whether he will be paying any type of fine for healthcare fraud committed over the three day span, but looking at other offenders who committed this similar act, Guerrero can possibly face a $2.75 million fine if convicted for the alleged health care fraud. (Coghill, 2015) III. Theoretical application Anyone in the medical field may seem trustworthy because most of the time they are. Unfortunately, there are those individuals who seek financial gain and are no longer trustworthy. There is no exact amount of how much fraud has been committed within the health care system, because it usually is never detected. Like in the case of Dr. Guerrero who committed a healthcare fraud scheme against his patients, employees of the health care system, and health care insurances. According to Vivek Pande and Will Maas, Dr. Guerrero was able to commit fraud against clients and the health care system and insurance providers; it is an ingenious crime, because the public considers them intelligent and high achieving individuals. (Pande & Maas, 2013) Overall, health care providers have a choice
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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.
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.
Almost every individual has become victimized in various capacities at one point by white collar crime (Friedrichs, 2010). Due to this, victimization of white collar crime it is highly disseminated and distributed. As a result, the aspects of the victims is highly heterogeneous (Friedrichs, 2010). In addition, even though white collar crimes are serious and cause harm many types of white collar crime are not generally considered to be a crime and the individuals affected are not considered victims. Some victims of white collar crime include employees who work in unsafe and unlawful conditions, consumers who are sold unsafe and price-fixed products or consumers who are victimized by deceitful and unethical practices (Friedrichs, 2010). Victims can also be differentiated into personal victims, organizational victims and tertiary victims such as the community (Friedrichs, 2010). There is insufficient information to claim that one group of individuals is statistically more likely to become victims of white collar crime because in general an individual is less likely to know that they have
White-collar crimes are just as prevalent today as ordinary street crimes. Studies show that criminal acts committed by white-collar criminals continue to increase due to unforeseen opportunities presented in the corporate world, but these crimes are often overlooked or minimally publicized in reference to criminal acts on the street. Many street crimes are viewed as unnecessary, horrendous crimes because they are committed by lower class citizens, whereas white collar crimes are illegal acts committed by seemingly respectable people whose occupational roles are considered successful and often admired by many (Piquero, 2014). These views often allow white collar crimes to “slip through the cracks” and carry lesser charges or punishment.
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
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.
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.
“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.
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.
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.
In this day and age, a corporation, family, or individual always has a potential risk of encountering fraud within their money supply. On average, fraud and abuse costs U.S. organizations more than $400 billion annually (Federal Bureau Investigation, 2010). Many may think that white collared crime is only money laundering or stealing, but that is only two out of the sum that countless culprits get away with. The term “white-collar crime,” originally coined in 1939 is synonymous with the full range of frauds committed by business and government professionals (Federal Bureau Investigation, 2010). These frauds include anything from bankruptcy fraud, money laundering, identity theft, corporate fraud to a wide number of threats all circling
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:
White-Collar Crime consists of occupational crime and corporate crime. Occupational crime refers to offences committed against legitimate institutions businesses or government by those with "respectable" social status. It includes the embezzlement of corporate funds, tax evasion, computer crime and expense-account fraud. It is not every day that we hear about white-collar crimes but these non-violent crimes are on the rise to the top. Federal Bureau of Investigation states that USA, for example recorded white collar crimes amounting $300 billion every year (Cornell University, 2010). White-collar crime is relatively a new idea. It has many aspects that are practical for study and further interpretation to clear some of its dark areas. White-Collar Crime was once introduced by Edwin Sutherland in 1939 during his speech in American Sociological Society. The following crimes actually performed are Bribery, Extortion, Insurance, Fraud, Embezzlement, Cybercrime etc. People who participate in these criminal activities are highly powerful and respectful among the society. The following activities include description about White-collar Crime, Investigation of White Collar Crime and The Consequences of committing a White-collar Crime.