GAAP
Failure of technology or inability to effectively meet the demands for a fully operational electronic health record, Removal of tax exemption/elimination of nonprofit status
Describe two controllable financial risks for health care service managers. How might those risks be avoided or abated? Fraud and abuse are two controllable financial risk. “Fraud consists of intentional acts of deception”, (Clevery et. al, 2011). Any person found guilty of health care fraud faces imprisonment and substantial fines. Any one person can commit healthcare fraud, just to name a few dishonest health care providers such as; physicians, dentists, labs corporations, and medical equipment suppliers or by plan members themselves. Examples of fraud are; billing for services not performed, falsifying patient diagnoses to justify test and procedures, accepting kickbacks for member referrals, waving copays, overbilling, forging or altering bills, and using someone else’s coverage or insurance.
Fraud and abuse occur from small private practices to large medical corporations, even with security systems in place health organizations are still vulnerable to breaches. So how can healthcare fraud & abuse be avoided? Companies can start with performing employee background checks, credit checks, and drug testing, Encrypting data, creating policies and procedures to prevent healthcare data breaches. A fraud and abuse expert can assist with creating such policies.
At least 3% of the money spent on health care each year in the U.S. involves fraud. The total is a staggering $68 billion a year, according to a 2008 report from the National Health Care Anti-Fraud Association.
Reference
Cleverly, W., Song, P., & Cleverly, J. (2011). Essentials of health care finance (7th ed.). Retrieved from The University of Phoenix eBook Collection database.
Describe two controllable financial risks for health care service managers. How might those risks be avoided or abated? Fraud and abuse are two controllable financial risk. “Fraud consists of intentional acts of deception”, (Clevery et. al, 2011). Any person found guilty of health care fraud faces imprisonment and substantial fines. Any one person can commit healthcare fraud, just to name a few dishonest health care providers such as; physicians, dentists, labs corporations, and medical equipment suppliers or by plan members themselves. Examples of fraud are; billing for services not performed, falsifying patient diagnoses to justify test and procedures, accepting kickbacks for member referrals, waving copays, overbilling, forging or altering bills, and using someone else’s coverage or insurance.
Fraud and abuse occur from small private practices to large medical corporations, even with security systems in place health organizations are still vulnerable to breaches. So how can healthcare fraud & abuse be avoided? Companies can start with performing employee background checks, credit checks, and drug testing, Encrypting data, creating policies and procedures to prevent healthcare data breaches. A fraud and abuse expert can assist with creating such policies.
At least 3% of the money spent on health care each year in the U.S. involves fraud. The total is a staggering $68 billion a year, according to a 2008 report from the National Health Care Anti-Fraud Association.
Reference
Cleverly, W., Song, P., & Cleverly, J. (2011). Essentials of health care finance (7th ed.). Retrieved from The University of Phoenix eBook Collection database.