| | |Health Care Fraud and Abuse | | | |
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Responsibility and Current Health Care Issues Paper - Health Care Fraud Roberta Roelofs HCS / 545 November 17‚ 2014 Michael Grossman Health care fraud is a current health care issue throughout the health care industry from hospitals to home care services. “The National Health Care Anti-Fraud Association (NHCAA) estimates that health care fraud accounts for at least three‚ but as much as ten percent of total health care expenditures”(Hubbell‚ 2006). Health care organizations that work with
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Health care fraud is a crime that has a significant effect on the private and public health care payment system. According to the Federal Bureau of Investigation‚ all health care programs are subject to fraud with Medicare and Medicaid being the most visible. It is estimated that fraudulent billings to both private and public health care programs are between 3 and 10 percent of total health care programs expenditures. The most recent Centers for Medicare and Medicaid (CMS) statistical estimates project
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The most interesting part in Gupta’s article is in her conclusion. The author notes that fraud in the health sector is a reality and should be exposed. Gupta further states that clinical operations are vulnerable to fraud because the system lacks effective mechanisms to detect‚ investigate‚ and prosecute individuals or groups of people who engage in fraud. Finally‚ the author calls on everyone in the health sector to develop a culture of research‚ which should be based on fundamentals of openness
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The Health Care Fraud Prevention and Enforcement Action Team (HEAT) And Its Effect on Health Care Compliance and Law Enforcement Thaedra Frangos ECM 627-Z1 Fraud Management: Risk and Compliance Professor Gary Reynolds Abstract The Health Care Fraud Prevention and Enforcement Action Team (HEAT) was created in 2009 in response to nothing short of an egregious and systemic theft problem bleeding our health care system and the American taxpayers near dry
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Grantham University Motivators of Fraud in Health Care: Paul L. Ewing G00019834 White-Collar Crime Mrs. Sandra J. Putnam December 25‚ 2012 What are the motivators of Health Care fraud? At first thought‚ I suspect it was for the love of money but then I felt like it has to be more to it than that. Why would people risk it all to defraud insurance companies and even the government? After a while‚ it’s clearly not about the money because the longer a company goes without being caught
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of identity theft. Experts believe that medical identity theft is increasing and now with all new technology it is hard to detect the costs of thieves. Taking people’s medical identity does not just affect that person it has a huge effect on the health care billing system. They are charged millions of dollars because of an incident. Studies show that ninety six percent of hospitals reported one data breach in two years. This shows that the average cost of data breaches rose and will continue to rise
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This paper attempts to analyze the fraud that is predominately a feature in the healthcare sector‚ unnecessary medical procedures‚ a term which means overutilization‚ overuse‚ or overtreatment. This crime’s expense alone accounts for about a third of healthcare spending in the united states ($750 billion out of $2.6 trillion. In the united states where the cost of taking care of one’s health is almost impossible‚ healthcare providers charges patients more to take care of needless or unwanted treatments
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Organizational Responsibility Organizational structure and culture influence have a huge effect on the success or downfall of an organization. Many organizations have proper processes in place to prevent health care fraud and abuse. This paper reviews fraud and abuse and how organizational structure and governance‚ culture‚ and focus on social responsibility affect or influenced the described situation. This paper will also review resources and allocation to prevent this type situation in the future
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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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