Fraud and Abuse in the Healthcare System

913 Words2 Pages

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. Multiple billing There are numerous amounts of billing codes within the Medicare system. Many have the same codes to one medical piece of equipment. If a biller tries to make a claim for a device, such as a wheelchair and walker, and the claim was denied based on excessive usage of that particular code because of its geographic region, then the biller can easily resubmit the claim using an alternative code that will allow the claim to go through with minor alternations to the device (AGHAEGBNO, 2001). The biller can complete this task several times until the claim is satisfied. The biller can also bill for services that were not provided in order to receive higher payments from health care providers. These are forms of multiple, double and improper billing abuses that are defrauding the system tremendously. Health care claims are coming in quickly and some payments are even expedited and reused to medical provide... ... middle of paper ... ...gram polices and laws that have been put in place by OIG are making an impact with tracking fraudulent providers and claims. Claims need to be reviewed to ensure each claims are before they are paid, to ensure money is not being wasted. Fraud and Abuse will remain a problem unless the government cracks down on providers. Works Cited Aghaegbuna,O (2011). Health care fraud and punishment. FDCH Congressional Testimony. Middle Search Plus “Fraud in Health Care: The scope of the problem.” (2012). Health Source-Consumer Edition Gatty.B (2010). Fighting Fraud US Government cracking down on those who commit healthcare scams “Dermatology Times,” 31 (11)12.Health Source-Consumer Edition Haddad,M (2010).Technology helps track healthcare providers. Health Management Technology, 31 (5), 24-25. Health Source-Consumer Edition

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