Healthcare Fraud And Abuse Essay

Fraud is all around us. Especially in the health care industry. What is being done to prevent fraud from reoccurring over and over in the health care industry? In the article “New medical codes can better catch fraud, but training is needed” by Tami Rockholt, RN, BSN; Mike Fossey; Mary McLean, BS discuses the topic of health care organizations transferring from ICD-9 to ICD-10 to help decrease fraud in the coding and billing department.

One of the major concerns in our industry is preventing health care fraud. In the past AngMar has dealt with healthcare fraud from dealing with new acquisitions as well as with patients’ doctors accepting kickbacks. The patients and the healthcare providers are notified beforehand if there are any out of pocket expenses, according to HIPAA compliance. AngMar lets all employees know coming in that they will periodically do checks on the end users’ systems to make sure that they are not doing anything that will infect the

“Healthcare Reform 101,” written by Rick Panning (2014), is a wonderful article that describes, in an easy-to-understand language, the Patient Protection and Affordable Care Act, signed into law March 23, 2010. The main goal of the Patient Protection and Affordable Care Act was to provide affordable, quality healthcare to Americans while simultaneously reducing some of the country’s economic problems. Two areas will be covered throughout this paper. The first section will include a summary of the major points and highlights of Panning’s (2014) article, including an introduction to the ACA, goals of the signed legislation, provided coverage, and downfalls of the current healthcare system. The second part will be comprised of a professional

In January 2014, CNN reported the death of nineteen veterans at a VA hospital due to delayed diagnosis and treatment (Singh, et al., 2010). On April 23, 2013, forty veterans died waiting to see a doctor at Phoenix VA health care system (Singh, et al., 2010). According to the CNN reporter, the patients were on a secret list meant to keep VA officials at Washington in the dark as a recently retired VA doctor disclosed. The Phoenix case is a representation of the trouble that the majority of veterans face while attempting to access medical services from VA hospitals. Since 1923, scandals have dominated the VA hospitals (Singh, et al., 2010).

One would expect that amount of money the US spends on healthcare to equate to great patient care and reduction of patient mortality, however, that is not

According to the FBI, healthcare fraud costs the country billions of dollars a year. Part of running a successful medical facility is to comply with HIPPA regulations. Title II of the Healthcare Insurance Portability and Accountability Act of 1996 (HIPPA) is concerned mostly with healthcare providers. Title II, also known as the privacy rule, addresses the prevention of Fraud and Abuse, administrative simplification and medical liability reform. The Healthcare Fraud and Abuse Control Program is a comprehensive program to combat fraud committed against both public and private healthcare plans.

In order for a business to get the upper hand, it would have to lower its prices. Other businesses would retaliate by also lowering their prices, turning down the overall price of healthcare (Cannon). As seen in Europe and Canada’s socialist healthcare systems, government healthcare reduces the quality of health services and greatly increases the wait times for elective surgery (Rogoff 75). The lowering of quality of medical services is due to the lack of any market drive to make it better. Instead of a business selling medical technology in order to make a return, the technology is handed out through government healthcare.

The ACA and the Health Care Delivery System a Critics have claimed that the ACA overlooked the need to reform the delivery system in our nation so as to constrain its costs and improve its quality. A careful examination of the law, however, shows that it constitutes one of the most aggressive efforts in the history of the nation to address the problems of the delivery system. Just over 5 years ago, on March 23, 2010, President Barack Obama signed the Affordable Care Act (ACA) into law. Its enactment may constitute the most important event of the Obama presidency and could fundamentally affect the future of health care in the United States. From a historical perspective, 5 years is a very short time, far too short to assess definitively the

Tile II started as provisions to combat fraud, waste, and abuse in healthcare industry. Several fraud and abuse control programs were established and makes revisions to previous sanctions and criminal law. Department of Health and Human Services (HHS) Office of the Inspector General (OIG) were in charge of investigating Medicare fraud and presenting cases for criminal or civil prosecution. Afterwards, states made their own implementation rules in order to comply with HIPAA. With states having variations in their rules, laws, and regulations, the nation’s healthcare industry became inefficient and ineffective.

(2012). The Ethics of Health Care Reform: Impact on Emergency Medicine. Academic Emergency Medicine, 19(4), 461-468 8p. doi:10.1111/j.1553- 2712.2012.01313.x U.S. Department of Health & Human Services. (2015).

These changes allow healthcare professionals to reap huge financial benefits for reporting Medicare fraud that is done by the healthcare industry. In some cases, people have been rewarded millions for reporting Medicare Fraud. People who report Medicare fraud are now able to receive up to 30 percent of the fines that are collected by the government. They are also able to receive full protection from retaliation. Hundreds of millions of dollars have been paid out by the United States government to people who have reported information about Medicare fraud.

Health care has been at the forefront of debate and public policy in the United States for decades. Ever since President Theodore Roosevelt proposed health care reform during his 1912 run for president, reform has been a policy position often espoused in American politics (Palmer 1). Certain types of health care reforms have been successfully implemented, such as Social Security in the 1930s, Medicare in the 1960s, and finally the Affordable Care Act in 2010. As the goal of the Affordable Care Act is to provide care for every American, the healthcare law is the closest the United States has ever approached to a single payer system; a health care system that provides universal care to every American. Despite that, current systems within the

Medicare is so underregulated and even will Medicare many Americans are still uninsured. The uninsured rate has gone down, but its still bad. Issitt noted that “Other major issues facing the Medicare system are rapidly increasing healthcare and medication costs, Medicare fraud--which amounts to billions of dollars each year--and an inability of politicians and the public to choose and implement improvements to the system.” (Issitt). This evidence by Issitt indicates how corrupt Medicare fraud is.

There have been several Acts and programs initiated to reduce the fraud and abuse of Medicare, all of which are crucial efforts that aim to reduce misuse and positively contribute to the financial state of healthcare in the United States. Robertson, B. (2011). Reporting and Returning Medicare and Medicaid Overpayments. Journal of Health Care Compliance, 13(5), 51-66.

In the film Escape Fire the Fight to Rescue American Healthcare, there were many insightful examples of why our Unites States healthcare revolves around paying more and getting less. The system is designed to treat diseases rather than preventing them and promoting wellness. In our healthcare industry, there are many different contributors that provide and make up our system. These intermediaries include suppliers, manufacturers, consumers, patients, providers, policy and regulations. All these members have a key role in the functionality of the health care industry; however, each role has its positives and negatives.