Health Care Fraud: The typically overlooked crime of healthcare fraud has resulted in a significant monetary loss on the part of the American public paying into government run medical programs, as well as private insurance company programs. Historically, we have seen that in any instance where money is involved people have found ways to or at least have attempted to obtain it illegally. Some do it through overt acts of violence such as a robbery. Others choose more covert ways of illegally obtaining money. This is usually conducted through fraudulent activities. This is the nature of white-collar crime. There is no force or violence involved but it is still illegal. (SSA) Obviously, when such a large amount of money is involved there is the potential for fraud and theft. White-collar criminals are constantly developing schemes to illegally obtain money they are not entitled to. In fact, the Federal Bureau of Investigation estimates that in 2011, three to ten percent of all health care expenditures were fraudulent. (FBI) Surprisingly for the category of white-collar crime, in 1993, Attorney General Janet Reno stated that health-care fraud the number two type of crime in America, after violent crime, respectively. (Sparrow) Therefore, while there are many types of fraud, health-care fraud is easier, safer and less high-risk than any other type. (Sparrow) With each of these factors being taken into account, health-care fraud is present real, enormous problems for the United State’s government, it’s people and private health-care industry. Overview A medical crime is any crime that takes place in the medical field. Though there are many aspect of this type of crime, health care fraud is one of the most notorious types of this cr... ... middle of paper ... ...H. and Tillman, R. (2010) Profit Without Honor; White- Collar Crime and the Looting of America (5th edition). Prentice Hall: New York Pogrebin M. R. (editor). (2012) About Criminals : A view of the Offenders’ World. Thousand Oaks, CA: Sage. Sade, R. M. (2012) INTRODUCTION: The Health Care Reform Law (PPACA): Controversies in Ethics and Policy. Journal of Law, Medicine and Ethics, 40(3) 523-525. Skeen, J. W. (2003) Heath Care Fraud and Industry Structure in the United States. Social Policy and Administration, 37(5), 516-526. Smothers, R. (2006, June 16). Health Care Group to Repay $265 Million to Medicare. NY Times. Retrieved from http://www.nytimes.com/2006/06/16/nyregion/16medicare.html?_r=1& Sparrow, M. K. (2008) Fraud in the U.S. Health-Care System: Exposing the Vulnerabilities of Automated Payment Systems. Social Research, 75(4), 1151-1180.
" With violence affecting so many lives, one can understand the desire driven by fear to lock away young male offenders. But considering their impoverished, danger-filled lives, I wonder whether the threat of being locked up for decades can really deter them from crime" (305). Hopkins is definitely not our stereotypical prisoner. Most generally, our view of prisoners is not that of someone who has this profound use of wording and this broad sense of knowledge.
Steiner, John E. (2013). Problems in health care law: challenges for the 21st century (10th ed.). Burlington, MA: Jones & Bartlett Learning.
Some federal statutes address fraud in government health care programs, and many of these laws vary considerably (Krause 2004). Some of these laws specifically target health care fraud. Example of the laws that the government direct at inappropriate health care activities includes the “Medicare and Medicaid Anti-Kickback Statute and Ethics in Patient Referrals Act (EPRA).”
Jacobson, P. (1999, July/August). Legal challenges to managed care cost containment programs: an intital assessment. Courts & Managed Care, 69-85.
The Patient Protection and Affordable Care Act passed by President Barack Obama is a significant change of the American healthcare system since insurance plans programs like Medicare and Medicaid (“Introduction to”). As a result, “It is also one of the most hotly contested, publicly maligned, and politically divisive pieces of legislation the country has ever seen” (“Introduction to”). The Affordable Care Act should be changed because it grants the government too much control over the citizen’s healthcare or the lack of individual freedom to choose affordable health insurance.
Collectively, the Department of Health and Human Services and the Department of Justice work to reduce healthcare fraud and investigate dishonest providers and suppliers. The Health Care Fraud Prevention and Enforcement Action Team recouped almost 3 billion in fraud, this year alone. Also, aggressive strategies exist to eliminate Medicare prescription fraud. Patients abusing or selling painkillers received by visiting several doctors and obtaining multiple prescriptions costs Medicare millions annually. Fraud affects everyone, preventing it requires government officials and citizens diligently working together.
In the documentary, Money and Medicine (2012), we learned that America is facing a health care crisis because over-diagnosis and over treatments (PBS 2012). This turns
Pozgar, G.D. (2012). Legal Aspects of Health Care Administration. United States of America: Jones and Bartlett Learning, LLC.
Shover, N, & Hochstetler, A. (2006). Choosing white-collar crime. New York, NY: Cambridge University Press.
The two major components of Medicare, the Hospital Insurance Program (Part A of Medicare) and the supplementary Medical Insurance program (Part B) may be exhausted by the year 2025, another sad fact of the Medicare situation at hand (“Medicare’s Future”). The burden brought about by the unfair dealings of HMO’s is having an adverse affect on the Medicare system. With the incredibly large burden brought about by the large amount of patients that Medicare is handed, it is becoming increasingly difficult to fund the system in the way that is necessary for it to function effectively. Most elderly people over the age of 65 are eligible for Medicare, but for a quite disturbing reason they are not able to reap the benefits of the taxes they have paid. Medicare is a national health plan covering 40 mi...
Rising medical costs are a worldwide problem, but nowhere are they higher than in the U.S. Although Americans with good health insurance coverage may get the best medical treatment in the world, the health of the average American, as measured by life expectancy and infant mortality, is below the average of other major industrial countries. Inefficiency, fraud and the expense of malpractice suits are often blamed for high U.S. costs, but the major reason is overinvestment in technology and personnel.
Gedge, E., & Waluchow, W. (2012). Readings in health care ethics (2nd ed.). Toronto, Ontario: Broadview Press.
The U.S. expends far more on healthcare than any other country in the world, yet we get fewer benefits, less than ideal health outcomes, and a lot of dissatisfaction manifested by unequal access, the significant numbers of uninsured and underinsured Americans, uneven quality, and unconstrained wastes. The financing of healthcare is also complicated, as there is no single payer system and payment schemes vary across payors and providers.
The reasons as to why individuals desist from crime can range from genetic, environmental, social, or psychophysiological. One belief focuses on the idea that criminals desist from crime through pro-social development and a worthwhile career path. In a study conducted by Aresti, Eatough and Gordon (2010), five ex-offenders participated in interviews about their lives as offenders, and their new found lives as productive members of society. Results show that four major themes emerged from the five men. First “being stuck” in their offending ways, second “defining moments” or moments of self-change, third “life in transition” or moments in the self-change process, and fourth “a new world” which encompasses the men’s new and reformed lives. The men in the study each had defining moments, typically the realization that they were going to be locked up for many years or losing out on time of their lives acted as this defining moment. This produced angst and made the men question their existence;
Champion, D 2011, ‘White-collar crimes and organizational offending: An integral approach’, International Journal of Business, Humanities, and Technology, vol. 1 no. 3, pp. 34-35.