Preview

The Role Of Fraud In Healthcare

Satisfactory Essays
Open Document
Open Document
181 Words
Grammar
Grammar
Plagiarism
Plagiarism
Writing
Writing
Score
Score
The Role Of Fraud In Healthcare
Health Care Fraud continues to be a huge issue across the board for health care providers, insurance companies, employers, employees, and the everyday common individual. Fraud affects every one is one way or another. Because medical fraud causes billions of dollars each year it forces insurance companies to have higher premiums resulting in a lot of out of pocket expenses. This then becomes a domino effect for companies by reducing employees benefits. resulting in the increase for all business owners and their overall expenses.

Most common type of fraud is billing for services that have not been rendered. Physician's are one of the most trusted in the medical field, but unfortunately also plays a huge part in committing medical frauds.

You May Also Find These Documents Helpful

  • Good Essays

    There are many examples of Medicare fraud. Some include: incorrect reporting of diagnoses or procedures to maximize payment, billing for services not furnished, alteration of medical documentation, billing non covered services as covered. Punishment for fraudulent and abusive activity can range from provider education and a request for overpayment, to assessment of Civil Monetary Penalties of up to $10,000 per service billed and/or criminal…

    • 783 Words
    • 4 Pages
    Good Essays
  • Satisfactory Essays

    Two Westchester County Hospital had overbilled the Medicaid program of $70 million dollars by improperly approving home care for Medicaid patients. The Attorney Generals Medicaid Fraud control Unit found out that the two hospitals were billing Medicaid beyond the cost of the drugs and made more than over a million dollars in profit. Both or the hospitals never admitted or denied the accusation. They decided to pay twice the fine that was against them. About 145 New York providers which includes the hospitals, physicians, group practices and individual practice have paid back an estimating amount of $19.9 million dollars back to the Medicaid Fraud Control Unit. Some health care leaders have brought up an important message regarding mistake with billing should be considered a fraud or not. In the article this is how t "A label of fraud is really not accurate and can discredit the institution in the community," Northern Metropolitan Hospital Association President and CEO Kevin Dahill told the Journal News. "Hospitals participate in these audits and agree to the findings. If they make mistakes, they correct them. That's not fraud," he said (Caramenico, Alicia; 2012, 4). In my opinion I don’t think that a mistake in billing should be considered a fraud. Sometime employers might type the worng procedure or diagnosis code due to reading a medical record notes in a patient chart wrong. I feel that when this happens the billing should be overlooked and be corrected. Once it has been corrected and it has been repeated then there is no fraud done at all.…

    • 623 Words
    • 2 Pages
    Satisfactory Essays
  • Powerful Essays

    Case Study for Fraud

    • 996 Words
    • 4 Pages

    The amount listed is the enrollment agreement was 10,020.00 which gives a difference of :…

    • 996 Words
    • 4 Pages
    Powerful Essays
  • Powerful Essays

    (Price & Norris, 2009) The money lost due to fraud increases the costs of providing a full range of legitimate medical services tremendously. Physicians may perform unnecessary procedures to increase reimbursement, which may compromise the safety of the patient. Further, when medical providers bill for services that were never rendered, they end up creating a false medical history for patients which may hinder them from obtaining disability or life insurance policies, at a later date. An inaccurate medical history also influences treatment decisions and allows some third party insurance companies to deny coverage based on a previous medical condition. Health care fraud also tarnishes the reputation of the medical profession and other health care service providers. Additionally, the efforts by the federal and the state government cost taxpayers billions of dollars a year, thus diverting the scarce tax money from other essential services and meeting the needs of elderly and the poor. This diversion of the taxpayer’s money often results in reduced benefit coverage, changes in eligibility for programs such as Medicaid, higher premiums for individuals or their employers, or higher…

    • 1739 Words
    • 7 Pages
    Powerful Essays
  • Better Essays

    Hcs 545 Week 5

    • 1438 Words
    • 6 Pages

    Fraud, waste and abuse can be described as the intentional deception to get an unauthorized or unwarranted benefit. A pharmacist that charges both the patient and the insurance company for a prescription is classified as fraud. A physician that prescribes unneeded tests for a patient to generate additional revenue is an example of waste. A pharmacist that receives a “brand necessary” prescription and enters the brand in the computer, charges the insurance company for the brand, but gives the patient a cheaper generic is an example of abuse Feldman (2001). Many deceptive actions classify into more than one of these categories and for this reason they have been merged into one category as fraud, waste, and abuse by the government.…

    • 1438 Words
    • 6 Pages
    Better Essays
  • Better Essays

    The National Health Care Anti-Fraud Association (NHCAA) estimates that the financial losses due to health care fraud are in the tens of billions…

    • 1070 Words
    • 5 Pages
    Better Essays
  • Satisfactory Essays

    The majority of health care fraud is committed by organized crime groups and a very…

    • 294 Words
    • 2 Pages
    Satisfactory Essays
  • Better Essays

    Fraud is any and all means a person uses to gain an unfair advantage over another person.…

    • 961 Words
    • 4 Pages
    Better Essays
  • Better Essays

    In 2012, the State of South Carolina spent $4.8 billion on the Medicaid program. At the end of that fiscal year, the US Department of Health and Human Services Office of Inspector General reported that nationwide only $1.4 billion had been recovered in fraudulent cases. “The US spends more than $2 trillion on healthcare annually. At least 3% of that spending-or $68 billion-is lost to fraud each year. Fraud accounts for 19 percent of the $600 billion to $800 billion in wasteful spending in the US healthcare system annually.” (Office of Inspector) No wonder our nation is in an economic breakdown in the health insurance market. The solution to Medicaid fraud may be as simple as spending more money on investigations and less time approving those who are just too lazy to work.…

    • 1756 Words
    • 5 Pages
    Better Essays
  • Satisfactory Essays

    Health care fraud and abuse is a current issue affecting everyone in the United States costing billions of dollars annually. This fraudulent crime is committed when dishonest consumers and providers submit false or misleading information to turn profit. It affects the United States by hampering the ability to provide affordable access health care and good quality of care to Americans. The Affordable Care Act prevention resources and tools are working to stop fraud before it occurs. The purpose of this paper is to discuss a health news situation affecting the health care system and evaluate the effect of organizational structure and governance, culture, and social responsibility. Recommended resources to preventing this situation in the future and recommended changes in future prevention will be discussed.…

    • 441 Words
    • 2 Pages
    Satisfactory Essays
  • Best Essays

    Medicare and Medicaid

    • 3491 Words
    • 14 Pages

    Fraud and Abuse of the Medicaid and Medicare programs in the United States is a widespread and pervasive problem. Institutions, health care providers and individual consumers all have a role in fraud and abuse prevention. It impacts everyone even if you do not currently benefit from one of these government programs.…

    • 3491 Words
    • 14 Pages
    Best Essays
  • Good Essays

    Healthcare fraud, while there can be simple billing errors that can create this, Medicare fraud normally arises when a physician, provider, or supplier is trying to steal from Medicare by fabricating services or products given to patients. While most people consider Healthcare fraud the same as Healthcare abuse, there is a big difference in meaning. Abuse differs, because abuse is committed when healthcare providers do not use Medicare’s processes which can exponentiate the costs to Medicare. There is a big difference between fraud and abuse, fraud is act committed with intention to rob money from Medicare while abuse is normally due to more paper management or documentation. (Coffin)…

    • 2041 Words
    • 9 Pages
    Good Essays
  • Good Essays

    Worker’s Compensation frauds committed by employers consist of the biggest percentage of all. According to Johnson, employers is the real problem behind the frauds as it is the most expensive for insurance companies. While some states like Florida, California, Texas and Ohio is fighting all types of Worker’s Compensation fraud, others do not. In the estimate provided by the Department of Labor, between 10 to 30 percent of employers misclassified some employess15. Since the premiums are extremely expensive for the employers, they often underreport the payrolls and misclassify their employees in order to reduce the premiums that they have to pay to get coverage. Underreporting and misclassification not only cheat the insurance companies which…

    • 826 Words
    • 4 Pages
    Good Essays
  • Good Essays

    Medicare Fraud

    • 335 Words
    • 2 Pages

    Medicare Fraud is presented in many different ways. Some examples of Medicare Frauds are: A healthcare provider bills Medicaid for services and equipment you never received, someone uses another person’s Medicare card for services or equipment, a company offers a Medicare drug plan that hasn’t been approved by Medicare, a company uses false information, etc. (www.medicare.gov). Medicare fraud causes increases in taxes, decreases in Medicare benefits, and an overall feeling of distrust in the health system among citizens. .…

    • 335 Words
    • 2 Pages
    Good Essays
  • Satisfactory Essays

    agree Healthcare fraud and Abuse is becoming a huge issue and very much a threat in the medical field. I'm already working in the Medical field and see it quite often attempted, it helps to know your job and know when others are trying to pull you into a situation like this because at the end of the day if you are caught doing this you will can and will loose your job and possibly be fined or jailed. The funny thing about fraud is just like I said know your job you can get a patient that comes into your place of work with a script from his/her doctor they are being tested for Diabetes but they haven't been diagnosed for it and they are on Medicare the code that the doctor has giving doesn't cover for Medicare. My first job is to call and see…

    • 182 Words
    • 1 Page
    Satisfactory Essays