Essay On Health Care Fraud And Abuse

Fraud & Abuse

The amount of money that is spent on healthcare is a quite a bit of money but about 10% of all the money is a result of some sort of medical fraud or abuse. This is about 120 billion dollars. With HIPAA (Health Insurance Portability and Accountability Act) medical fraud and abuse can be tracked easier. HIPAA was enacted in august of 1996; this was to help improve the portability and continuity of the health insurance.

Fraud

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,

HIPAA is there to help protected all the patients information no matter if is written down, oral and or an electronic record (Stember, 2005). There are more than one HIPAA rules that protect all aspects of the PHI. Some of those rules let the patient take hold of their healthcare. This lets the patient have more control over their health records. HIPAA lets the patient get their records when they want to view them. But they can’t get and medical records that are involved in a criminal or proceeding of any kind, and do not have the right to psychotherapy notes (Green, 2017).

HIPAA & Fraud and Abuse

HIPAA and fraud & abuse tie together in the way HIPAA protects the use the PHI in the billing and coding of claim form. No matter if the patient sells their information, HIPAA is there to help protect against fraud and abuse. One way HIPAA helps prevent fraud and abuse is in the case of preforming an audit. Although the government is the top payer in the US. Payers are the ones who do the audit of the offices. They make sure that what is on the claim matches what is on the patient’s record. This is how fraud and abuse can be stopped from continuing on.