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Challenges of healthcare fraud in the united states
Negative impacts of identity theft
Challenges of healthcare fraud in the united states
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It was a normal day at the Intern site, until a specific individual walked through the door. The client walked up to the front desk and stated that he has a new insurance card for me to copy. Rhonda Spence, the Office Manager gave him a look as if something was wrong. She leaves the office and states to the therapist that the client is using an insurance card that is not his. The therapist takes the client back to his office and informs him that he is suspected of identity theft. The client does not have health insurance, but his twin brother does. He was using his twin brother’s insurance card to receive behavioral health services. The twin brother is not aware of the situation. The client recognized the consequences of his actions. The law enforcement officials were called and he was arrested. The fraud investigators discovered that the individual has been receiving health care services at several different clinics with thousands of dollars in outstanding medical bills. Currently, he is being charged with medical identity theft and if found guilty he can be sentenced up to fifteen years of imprisonment, a fine, and pay restitution. As for the victim, more than likely he will not be responsible for paying the bills that the thief created. However, he will be left with a precarious credit situation, and he will deal with the emotional stress of regaining his good name. Medical identity theft is becoming a growing problem in the community. It is not only the fastest growing crime in the United States, but also the leading consumer fraud complaint in the country. There are several ways that identity theft is committed around the world. Identity thieves may target one individual or acquire personal information from thousands ... ... middle of paper ... ...rtler, Eric J. Prying Eyes. New York: Random House Reference, 2004, Print. Hansen, Michelle. Identity Theft. New York: Marshall Staeser, 2010. Print. Larkin, Eric. (2009). Medical Identity Theft. PC World. Vol. 27(issue 8), p49-49. Mancilla, Desla and Moczygemba, Jackie. “Exploring Medical Identity Theft”. Perspectives in Health Information Management. N.p. N.d. Retrieved on February 6, 2012 from http://perspectives.ahima.org/index.php?option=com_content&view=article&id=163&Itemid=56 Spence, Charles. Personal interview. 3 February 2012. Spence, Rhonda. Personal interview. 2 February 2012. The Red Flags Rule. American medical Association. N.p.N.d. Web. Retrieved on February 7, 2012 from http://www.ama-assn.org/ama/pub/physician-resources/practice-management-center/practice-operations/compliance-risk-management/identity-theft/patient-issues/red-flags-rule.page
...). Privacy and Health Information Technology. Journal of Law Medicine, 37(2), 121-149. Retrieved January 28, 2011 from CINAHL database
During the 1980’s, medical-related situations continuously occurred that made patients question their insurance policies as well as the privacy of their health care. Congress worked to create a bill containing strict rules regarding insurance policies and availability for one to keep their insurance if they are to move jobs. These rules were soon applied to all medical facilities and faculty and titled the “Health Insuran...
With today's use of electronic medical records software, information discussed in confidence with your doctor(s) will be recorded into electronic data files. The obvious concern is the potential for your records to be seen by hundreds of strangers who work in health care, the insurance industry, and a host of businesses associated with medical organizations. Fortunately, this catastrophic scenario will likely be avoided. Congress addressed growing public concern about privacy and security of personal health data, and in 1996 passed “The Health Insurance Portability and Accountability Act” (HIPAA). HIPAA sets the national standard for electronic transfers of health data.
Health care and health care information are turning to become unity and are working together to facilitate improvement of health care quality and equity. Therefore, health providers and other relevant stakeholders must strive to put in place strong measures capable of effecting heightened privacy and security precautions. More transparency must also be ensured when medical care organizations and institutions are handling patient’s medical data.
6. Should individuals and organizations with access to the databases be identified to the patient
...icare patients. Help put an end to healthcare fraud by identifying, reporting and preventing it from taking place.
Torrey, T. (2009, February 19). Limitations of electronic patient record keeping: Privacy and security issues. Retrieved June 29, 2011, from http://patients.about.com/od/electronicpatientrecords/a/privacysecurity.htm
considered a thief because they took the medications from the hospital without any consent or
The debate is still going on today about what can and cannot be done legitimately with patients health information. There are worries about who should be able to access the patient’s information and for what reasons do they have to be accessing the patient’s health information. While on the other side there is an increasing need for performance assessments, efficient health guard, and a proficient administration for more and better information. Health care services are now starting to realize that they have a lot of work to do to be in compliance with the current health laws on the state and federal level guidelines when it comes to dealing with protecting patient data.
Identity theft refers to unlawful activities which specifically compromise another person’s identity. According to the US Department of Justice (DOJ), identity theft is an activity “in which someone wrongfully obtains and uses another person’s personal data in some way that involves fraud or deception, typically for economic gain.” Such personal data can include names, Social Security numbers, birthdates, bank accounts, credit card numbers, or medical records. Identity theft can also be part of or enable other types of crimes such as bank, credit card, document, employment, or immigration fraud; robbery; and burglary, for example (Finklea, 2010, p. 2). Identity theft exists on a continuum with simple unauthorized credit card charges on one end all the way to having one’s identity completely assumed by another.
Health care fraud cases continue to be problematic for health care systems and providers across the United States. According to Pozgar (2012), these cases not only pose financial burdens on the accused, but may also lead to unnecessary risks to patients. A violation against the Federal False Claims Act, 31 U.S.C. §§ 3729-33, is one example of health care fraud that often enters into a settlement agreement. It is important to mention violations against the Federal False Claims Act, 31 U.S.C. §§ 3729-33, often allude to physician kickbacks as well (a violation against the Anti-Kickback Statute).
Today Identity Theft is the fastest growing crime in the United States. The Federal Trade Commission, identity theft victim complaint database currently contains more than three hundred thousand complaints. American consumers reported losing over one billion dollars to fraud overall in 2014, according to the Federal Trader Commissions annual report on consumer complaints released earlier this year, with the average cost ranging between five hundred dollars to two thousand dollars per victim (Federal Trade Commission, 2014). According to the 2011 Identity Fraud Survey Report, approximately eight million adults in the United States were victims of identity theft with the total cost of thirty seven billion dollars (Britz, 2013). The Federal Trade commission strongly urges people to take action in protecting themselves from Identity Theft because everyone is at risk of this rapidly growing crime no matter your age, race, gender or current financial situation. Identity Theft when a illegitimate person gains access to your personal information, such as your Social Security number, credit card account information, your mother's maiden name, your driver's license number, and other important information to impersonate someone. When the criminal has gained the information they need, they have the ability opens credit accounts, cellphone accounts, and other types of credit based accounts in your name. In addition once a person’s information is stolen the criminal then has the ability to access current accounts that is possessed, leading to even further damage to personal finance and credit.
Healthcare services have been on the rise for over 10 years now. According to a 2012 consumer alert, the industry provided $2.26 trillion in payments for more than four billion health insurance benefit claims in the year 2011(Fraud in Health Care). The bulk of the claims and the mainstream of fraud and abuse stem from the Medicare system professionals, who are knowledgeable about the process and persuade new clients into handing over their pertinent information in hopes of deception and illegitimate claims. Multiple and double billing, fraudulent prescriptions, are some of the major flaws in this organization that has made the healthcare services industry curdle. (AGHAEGBUNA, 2011) This is a non-violet crime and is often committed by very educated people including business people, hospital, doctors, and administrators.
This shows that identity theft is a growing problem that needs to be addressed (VanderPal). The United States Department of Justice, a branch of the United States government, defines identity theft as “terms used to refer to all types of crime in which someone wrongfully obtains and uses another person's personal data in some way that involves fraud or deception, typically for economic gain.” Identitytheft.info, a website edited by Rob Douglas, an identity theft expert, states, “…every individual or business is vulnerable to attack when it comes to personal or corporate information, products and services.” They also state, “As the methods used to perform identity theft expand, so do the types of accounts and services being stolen by identity thieves” (“Identity Theft Statistics”). As shown above, millions of people are being affected by identity theft in the United States, and it is only
The Health Insurance Portability and Accountability Act (HIPAA), Patient Safety and Quality Improvement Act (PSQIA), Confidential Information and Statistical Efficiency Act (CIPSEA), and the Freedom of Information Act all provide legal protection under many laws. It also involves ethical protection. The patient must be able to completely trust the healthcare provider by having confidence that their information is kept safe and not disclosed without their consent. Disclosing any information to the public could be humiliating for them. Patient information that is protected includes all medical and personal information related to their medical records, medical treatments, payment records, date of birth, gender, and