Healthcare Fraud And Abuse In Health Care
Health Care Fraud and Abuse
Health care quality designates a set of values that have to be met by healthcare providers as determined by various standards. Such standards examine whether healthcare services are of suitable quality to patients. The resultant outcome of any healthcare service provided by health practitioners ranging from the technical performance to interpersonal relationships depends on quality of the services. Healthcare fraud and abuse are some of the issues affecting the quality of healthcare services. According to the Blue Cross Blue Shield Association (2016), healthcare fraud is a felony in various states regulations that can occur in the form of deceits inside the healthcare systems purposively for illicit growth. On the
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This menace is characterized by high costs for employers and consumers because of the increased expenses and inefficiency (DHHS, 2014). As a result, patients are frequently exposed to unnecessary procedures. The methods used in fraud vary as those involved are in search of new approaches to outwit the bylaws. Every citizen pays the price of healthcare fraud, therefore, reduced health scheme benefits and treatment to meet the increased costs. The available evidence suggests that that every family in the US pays above $ 800 additional costs yearly due to fraud (Blue Cross Blue Shield Association, 2016). It is for this reason that this research becomes necessary to unearth the underlying fraud and abuse-related issues within healthcare. The paper explores the different types of frauds and abuse in the health sector. In addition, it discusses the impact of fraud and abuse on the American community, as well as possible solutions.
Literature Review
This section discusses the various types of frauds. These include upcoding, identity theft, billing of unnecessary services and overcharging of simple services offered by health care providers. Further, it highlights the consequences of fraud and abuse on community and ways of solving the issues to reduce the burden of the associated costs on citizens.
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One of the common forms of healthcare fraud under discussion is the unnecessary billing of items or services. This is a fraudulent act committed by filling a claim that does not apply to a patient’s conditions. A case in point is the billing of an echocardiogram for a patient with eye problems. Such kinds of unnecessary exploitation of healthcare services have to be safeguarded under the Social Security Act. The Act provides the procedures and guidelines on the payments of search services (DHHS & Department of Justice,
The Federal Anti-Kickback Statute
144 Words | 1 PagesOne of the well-known federal fraud and abuse statutes in the United States is the federal Anti-Kickback Statute, which greatly influences business relationships in the pharmaceutical, healthcare and medical device sectors. This statute is an Anti-Corruption law, which is designed to protect beneficiaries of the federal health care program from money influence on various referral decisions. Thus, this law helps in guarding against an increase in costs, overutilization and poor quality services. However, this law needs some modifications to become more efficient to all the U.S citizens. The lawmakers in the country should take the initiative of amending this bill so as to ensure that they adequately represent the interests of those people who
Icd-9 In The Health Care Industry
424 Words | 2 PagesFraud is all around us. Especially in the health care industry. What is being done to prevent fraud from reoccurring over and over in the health care industry? In the article “New medical codes can better catch fraud, but training is needed” by Tami Rockholt, RN, BSN; Mike Fossey; Mary McLean, BS discuses the topic of health care organizations transferring from ICD-9 to ICD-10 to help decrease fraud in the coding and billing department.
HIPAA Compliance Risk Analysis
1369 Words | 6 PagesOne of the major concerns in our industry is preventing health care fraud. In the past AngMar has dealt with healthcare fraud from dealing with new acquisitions as well as with patients’ doctors accepting kickbacks. The patients and the healthcare providers are notified beforehand if there are any out of pocket expenses, according to HIPAA compliance. AngMar lets all employees know coming in that they will periodically do checks on the end users’ systems to make sure that they are not doing anything that will infect the
Montana Code 50-602
753 Words | 4 PagesIn this case, criminal charges are established between healthcare organizations and the government. The punishment may involve a fine and/or imprisonment (McWay, 2014, pp.
Claudia Kalb Do No Harm Analysis
644 Words | 3 PagesClaudia Kalb’s article “ Do No Harm,” published in the October 4, 2010, issue of Society, discuses the healthcare professionals’ defensive behavior that causes the malpractices among patients. Kalb reports that since the Health system’s applied the lawyer Boothman’s program of “ disclosure and compensation,” then the number of lawsuits reduced as well as the legal- defense costs have dropped around 61 percent. In 1999, there were around 100,000 Americans people are killed from the preventable medical errors, noted Kalb. Also, the header of Centers for Medicare and Medicaid Services even claims that there won’t be any refund to the hospitals for preventable medical error cases. According to Kalb, Harvard’s Institute for Professionalism and
Healthcare Reform 101 Summary
588 Words | 3 Pages“Healthcare Reform 101,” written by Rick Panning (2014), is a wonderful article that describes, in an easy-to-understand language, the Patient Protection and Affordable Care Act, signed into law March 23, 2010. The main goal of the Patient Protection and Affordable Care Act was to provide affordable, quality healthcare to Americans while simultaneously reducing some of the country’s economic problems. Two areas will be covered throughout this paper. The first section will include a summary of the major points and highlights of Panning’s (2014) article, including an introduction to the ACA, goals of the signed legislation, provided coverage, and downfalls of the current healthcare system. The second part will be comprised of a professional
Argumentative Essay: Should Carla Tell?
398 Words | 2 PagesLying and cheating are dishonest behavior that can get you in trouble. In health care the state has set up a law on personal gain. You cannot ask for, or accept monetary gain over a certain amount to improve your business. It is called the anti-kickback statute (AKS). (hhs.gov pg,4) “The AKS is a criminal law that prohibits the knowing and willful payment of “remuneration” to induce or reward patient referrals or the generation of business involving any item or service payable by the Federal health care programs (e.g., drugs, supplies, or health care services for Medicare or Medicaid patients.”
ACA Annotated Bibliography
908 Words | 4 Pages(2012). The Ethics of Health Care Reform: Impact on Emergency Medicine. Academic Emergency Medicine, 19(4), 461-468 8p. doi:10.1111/j.1553- 2712.2012.01313.x U.S. Department of Health & Human Services. (2015).
Essay On Continuum Of Care
530 Words | 3 PagesThere are many things that define and promotes the use of accreditation as a means of accountability across the continuum of care. The market, regulation, and professionalism all affect the use of accreditation as a means of accountability across the continuum of care. The role of the market play in defining and promoting the use of accreditation as means of accountability across the continuum of care is that money talks. Health care purchasers and consumers can use money as a mean to stimulate organizations to improve quality by either rewarding or punishing the organization base on performance or progress. (1) Healthcare consumers and purchasers are demanding more information regarding quality of care.
Medicare Billing Violations
186 Words | 1 PagesI think it’s wrong for the government to penalize physicians for not meeting compliance standards. However, It’s a great opportunity for the government to aim at small practices because this is where physicians are self-employed. These types of physicians have numerous clinic or health care facilities and are most likely to commit fraud. This seems kind of biased, but it’s true. According to, Ornstein, the most common sanctions are against physicians who have odd Medicare billing reputations (2014, title).
Medicare Fraud Research Paper
301 Words | 2 PagesMedicare fraud is a very common occurrence in the United States. However, there are whistleblowers who are working hard to stop Medicare fraud. The vast majority of people who report Medicare fraud are healthcare professionals. This includes people such as ambulance drivers, physicians, nursing home workers, hospice workers and nurses. There have been some changes recently to the United States whistleblower laws.
Pros And Cons Of Health Care
741 Words | 3 PagesIt can be quite prevailing for individuals to have financial problems towards health coverage. Based on the Health Affairs reference, “In the last decade, health insurance premiums costs have increased by 80%... whereas 58% of Americans report they are not able to seek medical attention due to high costs” (Gary Claxton, Matthew Rae, and Nirmita Panchal, et al). Statistics also present many factors exhibiting millions of individuals facing the risk of losing their insurance. Above all, health insurance is a basic health necessity. Medical services being available to everyone will benefit the public health not only with quality, but along with quantity.
Escape Fire Analysis
1358 Words | 6 PagesIn the film Escape Fire the Fight to Rescue American Healthcare, there were many insightful examples of why our Unites States healthcare revolves around paying more and getting less. The system is designed to treat diseases rather than preventing them and promoting wellness. In our healthcare industry, there are many different contributors that provide and make up our system. These intermediaries include suppliers, manufacturers, consumers, patients, providers, policy and regulations. All these members have a key role in the functionality of the health care industry; however, each role has its positives and negatives.
Importance Of Accountability In Healthcare
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Rhetorical Analysis Of Michael Moore's Sicko Documentary
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