HEALTHCARE FRAUD essay
This is due to the losses incurred by insurance companies which must be recovered. Research has also shown that there are three types of fraud in context to health care fraud and this include: health insurance fraud, drug fraud, and medical fraud. The primary goal of all the three types of fraud is to profit financially. It may also be to obtain medical care without valid insurance. Due to these cases both the state and federal laws are in place to prevent health care fraud and to punish those who commit this crime. • The provider can falsify a patient's diagnosis to justify surgeries, tests or other procedures that aren't medically necessary. • There is the case of unbundling; this is where the provider charges for every step as it were a separate step.
The Medicare cannot realize this since his only concern is to get better or get relieved from the pain he is feeling. • They also provide a service that is not covered under a patient's insurance policy then bill for a service that is covered. They achieve this motive through misinterpreting non-covered treatments as medically necessary covered treatments for a purpose of obtaining insurance payments. Criminal and Civil Penalties for Health Care Fraud Anyone defrauding other people is a criminal and as such should be treated like one. Actually, healthcare fraud is regarded as a felony, therefore; anyone found guilty of defrauding should be imprisoned for a year(s) in accordance with the amount of money he took. They can also be fined or restituted.
The other way and which is opted by many people is being subject to a civil lawsuit. This simply means that the victim of fraud can take the case to court and sue the criminal behind the fraud for repayment of the amount they took. Anti –kickback Statute targets individuals who knowingly and willfully pay, solicit, offer or receive remuneration directly or indirectly to induce or reward referrals of services and items provided by healthcare programs. The Physician Self-Referral Law prohibits providers from making referrals for certain health care services. Health Care Fraud Statistics Many people are aware that fraud takes place but they do not know is the amount of money it costs countries on an annual basis. This s because health care fraud does not seem to be like a crime to hurt others but it certainly has negative impacts.
For instance, statistics show that as of 2015, the National Health Care Anti-Fraud Association (NHCAA) estimates that the U. Furthermore, they are required to appoint a Chief Compliance Officer and other compliance staff charged with operating and monitoring the compliance program and reporting to the hospital's government body. They should also implement continuous education and training for staff, ensure that there is maintenance of a process to receive health care fraud reports and complains, establish a system to respond to healthcare fraud and abuse accusations and appropriate disciplinary actions against staff who violet compliances laws (Healthcare Fraud: (1999) Investigations and Enforcement Issues) In addition, they should use audits or evaluations to track compliance adherence and help reduce issues, also consider investigations and recommendations of systemic problems and the establishment of policies to address if staff involved are retained or terminated.
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