Health care is an area that is very heavily abused in the Unites States. A huge amount of money and resources are put into providing excellent health care in this country. But the percentage of fraud in health care is equally huge. A large number of insurance claims are designed to abuse the health care system. Although they are not significant in number, these fraudulent insurance claims can cause a sizeable dent in the economy. The National Health Care Anti-Fraud Association (NHCAA) estimates that 3 to 10 percent of the annual expenditure in health care is due to fraud and abuse of insurance claims.
Fraud in healthcare can be carried out in various ways:
• Distortion of services rendered for treatment with incorrect Current Procedural Terminology
“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
Steven Brill’s Bitter Pill: “Why Medical Bills Are Killing Us,” by Angelina Salikhbaeva Summary: Steven Brill in the article “Bitter Pill: Why Medical Bills Are Killing Us” clarifies his opinion about the costs of healthcare services in the United States. The author writes about different stories of how families become bankrupt or unable to pay the total cost of the treatment to the US hospitals and related medical facilities. According to Steven Brill’s article, the US hospitals prescribe too much health care to patients.
The affordable care act presented the United States with the most extensive overhaul since the passage of Medicare and Medicaid in the 1960’s. The act was a response to staggering statistics on the price of healthcare and the resulting uninsured rate within the United States. The affordable care act uses Individual Mandate and Health Insurance Exchanges to combat major factors causing high insurance cost and low insured rates. As with most reform, the public has not been one hundred percent unified on the potential effectiveness of the Affordable Care Act.
Social contracts in America have been molded around public policy through the years. Public policy is influenced by the citizens of America and the countries stability. Social contracts like the Affordable Care Act (ACA) conveys a political message that the government is establishing a social contract with the citizens of America. The ACA established a social contract with physicians and hospitals by mandating rules and regulations. However, both social contracts have flaws that can hinder physician and patient relationship, care, and cost.
With those that are insured favoring a moral hazard and overusing the system could lead to a negative impact on our health care system leaving those who truly needing services paying a higher premium or
In addition to the dismay of many healthcare professionals, patients, and citizens who are uninsured, several flaws about the current healthcare system show the necessity for reform. The three flaws that exacerbate the current healthcare crisis are: the tax code and tax breaks, the lack of preventable care and adequate care of chronic diseases, and administrative costs. A single payer, universal healthcare system can resolve the major flaws of the
Medicare 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.
The United States is the only Western nation that does not authorize free health services to its people. The cost of healthcare to the uninsured is beyond prohibitive, and insurance plans are far more captivated with profit costs, rather
Carolyn, Thanks for sharing your thoughts. Medical fraud and abuse are the serious problems for health care system, which need to be prevented from reducing the health care cost and providing quality of services to the people who need care. It is most important to educate health care worker and new employees about these issues so that they will be aware providing patient 's personal information to others. Also, potential providers need to be surveyed to ensure that they are reasonable providers or
46.8 million Americans were reported as uninsured in 2013, which equivocates to one sixth of the population. Those without insurance have revealed that they risk “more problems getting care, are diagnosed at later disease stages, and get less therapeutic care” (National Health Care Disparities Report) and those insured risk losing their insurance. Inadequately covered citizens are often working-class individuals who simply cannot receive insurance due to uncontrollable inconveniences and therefore jeopardize having medical coverage. In these instances, Americans have a chance of being diagnosed with diseases that they had no opportunity to prevent or could not diagnose them at an early stage of the illness. Patients have suffered unnecessarily due to lack of health care, and “18,000 Americans die every year because they don't have health insurance” (PNHP).
Are You Really the Impacted person? Medical excellent care Recognition fraud Facts You Did not Know The public has become more equipped against the risks of identity robbery. While identity fraudsters can get people's money, harm there a favorable credit score ranking and cause years of disappointment and stress, an alternative form of identity robbery, health care identity robbery, can actually jeopardize lives.
There have been several Acts and programs initiated to reduce the fraud and abuse of Medicare, all of which are crucial efforts that aim to reduce misuse and positively contribute to the financial state of healthcare in the United States. Robertson, B. (2011). Reporting and Returning Medicare and Medicaid Overpayments. Journal of Health Care Compliance, 13(5), 51-66.
Fraud and abuse in the United States' healthcare system have attracted a lot of attention in recent years. The healthcare system in the United States has been overwhelmed by massive fraud and abuse tactics, with far-reaching ramifications for the government, lawmakers, and the public. The government has had to allocate significant resources to monitor and control fraud and abuse in the healthcare industry. Lawmakers have also been in the hook to pass new laws and regulations to stop fraud and abuse in the healthcare system. On the other hand, the public has had to bear the problem of higher healthcare costs due to fraud and abuse in the system.
Sicko is an American documentary by Michael Moore which explores the status of health care in America. In my opinion, he has presented a clear-cut viewpoint that American health care is not producing results. Nearly half a hundred million Americans, according to Sicko, are not insured while the rest, who are insured, are often sufferers of insurance company deceit and also red tape. Additionally, Sicko mentions that the United States health care system is placed 37th out of 191 by the W.H.O. with definite health measures, like the neonate death and life probability, equivalent to countries with quite less financial wealth. Interviews are carried out with individuals who supposed they had sufficient coverage but were deprived of care.
There is proof and evidence that Americans citizens do not receive the healthcare that they need despite the fact that the U.S. spends more funds per individual on health care than compared to any other country. Individuals who are battling prolonged diseases such as, diabetes, high blood pressure, or heart disease does not get the established and actual treatment that they should. For example, these individuals should be receiving drug therapies or self-management services so that they can assist them more efficiently and help them control their conditions. This goes for every American citizens that is uninsured, insured, or under-insured. These problems that the individuals are facing are only worsen due to the fact of lack of coordination