Fraud and Abuse in Healthcare Essay
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 …show more content…
Employees who have access to ERH modules and billing modules in a provider entity could be able to enter fraudulent encounters, generate billing, and then delete documented encounter data. (Fraud in Health Care) 2010.
Forged prescriptions Fraudulent prescriptions are also on the rise. Physicians are writing illegal prescriptions that are billed for a claim for reimbursement, but have yet to see a bill of rendered services that called for the actual prescription. This often ends up happening to a patient who has little or no medical issues and has never been seen before. The provider who receives the forged prescription profits an anticipated amount of 15% to $20% in profits. (AGHAEGBUNA ,2011). There are four types of fraud that healthcare providers’ organization face. Patient fraud, provider employee fraud, provider billing fraud and payer fraud, even though providers need to receive payment for their service they should be more preventative action in place to ensure that these fraudulent activities can be detected.
Fighting Fraud
According to the new law the OIG’s effectiveness will be detecting fraud and abuse by expanding access to and uses of data for conducting oversight and law enforcement activities, including data-matching agreements between agencies. (Gatty, 2010). The HHA will establish procedures for screening providers and suppliers participating in Medicare, Medicaid and the Children’s Health Insurances program to prevent...
