Summary and Conclusion
This study sought to answer three research questions. Although the questions have been presented in previous chapters, they are worth presenting again.
What are the major federal laws and policies related to health care fraud?
How have these laws and policies been used to control fraud, waste, and abuse in federal health care programs?
• What are the impacts of these laws and policies on the war against health care fraud?
To address the questions comprehensively, the researcher conducted a historical research that blended the research elements of documentary research and content analysis. The use of historical research provided opportunity to travel through time and trace the origin and evolution of the laws on health care fraud. Through historical research, the research identified the laws that relate directly or indirectly to health care fraud. Statutes on health care fraud can be grouped into two: those that are “traditional generic” laws and health care fraud laws. While the “traditional generic” laws apply to fraud in general, health care fraud laws are the statutes Congress enacted to address certain issues within the health care milieu.
As presented in previous chapters, the “traditional generic” law include the False Claims Act of 1986, Anti-Kickback Statute, Stark Law (Self-Referral), and Deficit Reduction Act. Congress enacted these laws at different time in the history of the United States to deal with issues of unlawful practices. Originally, Congress did not enact these laws to prevent health care fraud. In short, some of the traditional-fraud laws were already in use before Congress passed the amendments to the Social Security Act of 1965 to create Medicare and Medicaid....
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The Health Insurance Portability and Accountability Act, most commonly known by its initials HIPAA, was enacted by Congress then signed by President Bill Clinton on August 21, 1996. This act was put into place in order to regulate the privacy of patient health information, and as an effort to lower the cost of health care, shape the many pieces of our complicated healthcare system. This act also protects individuals from losing their health insurance if they lose their employment or choose to switch employers. . Before HIPAA there was no standard or consistency for the enforcement of the privacy for patients and the rules and regulations varied by state and organizations. HIPAA virtually affects everybody within the healthcare field including but not limited to patients, providers, payers and intermediaries. Although there are many parts of the HIPAA act, for the purposes of this paper we are going to focus on the two main sections and the four objectives of HIPAA, a which are to improve the portability (the capability of transferring from one employee to another) of health insurance, combat fraud, abuse, and waste in health insurance, to promote the expanded use of medical savings accounts, and to simplify the administration of health insurance.
One of the biggest contributors to health care costs that I have seen during my time in the healthcare industry is insurance fraud. One example of such fraud came about two months ago. I was taking a phone call from a provider that was upset that one of their claims had denied even though all of their previous claims had been paid. In researching with a partner plan it was determined that the claim denied because this medical provid...
Fraud is putting the wrong information or up codding the codes on the claim form. This can be done by the doctor, biller and coder, and the patient selling their insurance number to false company. The false company can bill the insurance company, for false information whether it is services, medication,
The United States (U.S.) has a health care system that is much different than any other health care system in the world (Nies & McEwen, 2015). It is frequently recognized as one with most recent technological inventions, but at the same time is often criticized for being overly expensive (Nies & McEwen, 2015). In 2010, President Obama signed the Patient Protection and Affordable Care Act (ACA) (U. S. Department of Health & Human Services, n.d.) This plan was implemented in an attempt to make preventative care more affordable and accessible for all uninsured Americans (U.S. Department of Health & Human Services, n.d.). Under the law, the new Patient’s Bill of Rights gives consumers the power to be in charge of their health care choices. (U.S. Department of Health & Human Services, n.d.).
Human Services is a profession that has been deeply affected by certain legislation passed by Congress. One of the most influential acts that has been passed, was the “Patient Protection & Affordable Care Act”, put in effect by President Barack Obama in 2010.This legislation has affected the department of Human Services profoundly more than any other legislation in the past decade. Many positive changes have been made but, many could argue the downside of some changes as well. It is critical in this line of work, to study and evaluate both sides of the arguments to better the ability to treat and help others.
This act greatly changes the American health-care system. It grants the government too much control over the healthcare of its citizens since “The Patient Protection
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Medicare fraud occurs when healthcare providers, suppliers, and private companies charge for services or supplies patients never receive. Additionally, abuse of the Medicare program also occurs because physicians and suppliers do not always follow best medical practices which leads to excessive costs through improper payments, or medically unnecessary services, both of which abuse the program. Conservative estimates suggest he...
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Our healthcare system has developed into a burden for most people and has terrible consequences for others. It consists of everyone paying for healthcare as a whole, instead of people paying for themselves. This system of healthcare has burdened the people who take care of themselves and have money, but extends the life of people who do not take care of themselves and live in poverty. This is not pleasant for the one’s who decided to go to school and make well over minimum wage. In turn, they are the individuals who end up paying for the people who decided to make bad decisions in their life that put them in the minimum wage position. Clearly, laws regulate the insurance companies but these regulations do not make any sense to many. Balko explains that, “More and m...
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