Health Care Management Cluster 14 November 2011 Research Paper U.S. Health Care and Compliance A System Challenged By Schemes‚ Scams‚ Fraud‚ and Abuse “Laws are made to restrain and punish the wicked; the wise and good do not need them as a guide‚ but only as a shield against rapine and oppression; they can live civilly and orderly‚ though there were no law in the world.” John Milton (1608-1674) On August 31‚ 2010‚ in Los Angeles‚ California‚ the former chief
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Running head: HEALTHCARE FRAUD AND ABUSE Healthcare Fraud and Abuse Abstract Rising costs of healthcare is a valid concern for many households in America. A factor in the cost of healthcare insurance is fraud. Fraud is often very difficult to detect. The magnitude of healthcare fraud is unknown. Initial reimbursement and payment and billing timeframe of 90 days allows for fast payment of services‚ however‚ many times before there is an indication of fraudulent billing the company has closed
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Healthcare Fraud and Abuse As we head into the next four years under the Obama administration‚ many Americans are hearing more and more about healthcare reform and what needs to be done to fix the ailing healthcare system. Part of the dramatic increase in healthcare costs is due to Medicare fraud abuse. Healthcare fraud is defined as making false statements or representations of material facts in order to obtain benefits or payment. Healthcare abuse is defined as practices involving the overuse
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Health Care Fraud 1. Types of Health Care Fraud A. Health insurance B. Drug Fraud C. Punishment 2. Entities involved in Health care fraud A. Social a. Individuals B. Political a. Oversight b. Supreme Court input C. Cultural 3. Technology and health Care Fraud A. Billing Procedures B. Unbundling 4. Ethics involved with Fraud/Economic Impact a. Effects on Health Care b. Monitor outgoing monies
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Fraud is a serious crime that should concern all parties of the U.S. health care system and is a costly reality that the government cannot overlook. While not all fraud can be prevented‚ by learning about the many different types of fraud‚ patients can be educated on how to protect themselves from fraud. If we use government programs to inform the public that they can be targeted‚ the dollar amount for these cases for fraud can be reduced. An informed public and a properly funded FBI will go a
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Fraud‚ Abuse‚ and Waste in the US Healthcare System Tony Hackman University of Phoenix Financial Management in Health Care HCS/577 Adam Craft August 01‚ 2010 Fraud‚ Abuse‚ and Waste in the US Healthcare System Healthcare insurance costs have risen at the average rate of three percent over the inflation rate for the past 10 years. As a result‚ the government is spending a larger percentage of GDP on healthcare for Americans. One of the reasons for this increase in the overall cost for healthcare
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average cost of data breaches rose and will continue to rise depending on how many theft incidents will occur in a time period. Data breaches also roll over into hospitals‚ which means it will run them around twelve billion dollars. The medical industries are not well up dated on detecting and preventing identity theft. Which is not a good thing; they should have the ability to be informed on what is going on with patient’s medical records. They are held responsible and no one will trust them if
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Healthcare Fraud - is knowingly and willfully executes or attempts to execute a scheme to defraud any healthcare benefit program‚ or to obtain by false or fraudulent pretense. Therefore‚ in order to prove fraud the government must prove that the act performed was knowingly‚ willfully and intentionally. Healthcare Abuse - is most frequently defined in terms of acts that are inconsistent with sound medical or business practice‚ is an unintentional practice is directly or indirectly results in an over
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Healthcare fraud is a major issue in our Healthcare system. It affects our overall economy and well-being of our citizens. There are many different types of healthcare frauds such as insurance fraud‚ drug fraud and billing fraud. Insurance fraud occurs when the insurance provider is given false insurance claims with the intent to defraud. As a result of frequent false insurance claims‚ the inspection procedure uses the best available experts and verification process to check the false claims
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electronic devices. Healthcare is no different‚ trying to take advantage of technological breakthroughs in order to provide best possible care for the patients. With wide use of emails‚ the Health Insurance Portability and Accountability Act (HIPAA) regulations get challenged every day and no healthcare organization wants to be on the wrong side of the law. “While rapid improvements in information technology may be seen by many as a blessing‚ when applied to the healthcare industry‚ these advances
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