Analyze a Contemporary Health Care Issue
Introduction to Health Care Finance (HCA 240)
Analyze Contemporary Health Care Issue
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 dollars for the government and other financers of health care in the United States.
Fraud in health care is considered a “white-collar crime that involves the filing of dishonest health care claims in order to turn a profit” (Cornell University Law School, n.d., para. 1). Some of the most common health care fraud includes billing for care that was not delivered, filing a claim multiple times for one treatment, upcoding to increase a reimbursement, and accepting payment or making payments for referrals. (Cleverley, Song, & Cleverley, 2011) The fraud listed above represents only a few of the defined fraud and abuse problems of health care. Just listing these few examples of fraud makes it easy to understand why new regulations have had to be put into place for preventing all types of fraud
Both for profit and non-profit medical providers will be affected by these new regulations. The first impact will be the cost of implementing new technological advancements that help to identify and track possible fraudulent activity. Increased waiting times in obtaining licenses because of increased scrutiny of past performance and background tests may also occur. This is especially true for specific health providers in which a high
Analyze Contemporary Health Care Issue
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 dollars for the government and other financers of health care in the United States.
Fraud in health care is considered a “white-collar crime that involves the filing of dishonest health care claims in order to turn a profit” (Cornell University Law School, n.d., para. 1). Some of the most common health care fraud includes billing for care that was not delivered, filing a claim multiple times for one treatment, upcoding to increase a reimbursement, and accepting payment or making payments for referrals. (Cleverley, Song, & Cleverley, 2011) The fraud listed above represents only a few of the defined fraud and abuse problems of health care. Just listing these few examples of fraud makes it easy to understand why new regulations have had to be put into place for preventing all types of fraud
Both for profit and non-profit medical providers will be affected by these new regulations. The first impact will be the cost of implementing new technological advancements that help to identify and track possible fraudulent activity. Increased waiting times in obtaining licenses because of increased scrutiny of past performance and background tests may also occur. This is especially true for specific health providers in which a high
References: Cleverley, W. O., Song, P. H., & Cleverley, J. O. (2011). Essentials of Health Care Finance (7th ed.). [GCU electronic version]. Retrieved from http;//www.gcu.edu Cornell University Law School. (n.d.). Health Care Fraud: an Overview. Retrieved February 2, 2013, from http://www.law.cornell.edu/wex/healthcare_fraud Health Care Fraud. (n.d.). Retrieved February 1, 2013, from http://www.fbi.gov/about-us/investigate/white_collar/health-care fraud HEAT Task Force. (n.d.). Retrieved February 3, 2013, from http://www.stopmedicarefraud.gov/aboutfraud/heattaskforce/index.html New Tools to Fight Fraud, Strengthen Federal and Private Health Programs and Protect Consumer and Taxpayer Dollars. (2012). Retrieved February 1, 2013, from http://www.healthcare .gov/news/factsheets/2012/02/medicare-fraud02142012a.html