Health care fraud is the most important area to be analyzed as it put a great impact over US health care system. The reason behind the increasing cost is healthcare fraud. Increasing cost can be considered as the most visible factor in this term. US health care system is continuously using money over the health care system in order to make it better and protect patient from getting ill. Therefore, they have faced millions of challenges and for that they have spent more than 2.27 trillion dollars over the health care and 4 billion over health insurance. But these insurance claims turned about fraudulent (The Challenge of Health Care Fraud, 2014). In my essay I am going to elaborate about the types of frauds, and my thesis statement here lies as “Types of frauds and committed by whom in health care system? Who can be suspected for this act and what can we do for future to remove these fraudulent?” The Impact Of Fraud On Health Care Cost A) Increase In Cost For Lots Of Americans: Fraud has a great impact over the health care system, it has known for rising it costs continuously over ages. It has been estimated that 28 billion dollars are being spent every year approximately, which means 6300 dollars as an average …show more content…
This means that medicines are ambiguous resulting in complex health policy. This leaves the citizens of US in dark due to increasing high cost and unknown of the pricing schedules. This leaves US in high percentage of increasing frauds daily. Citizens do not know what exactly is the cost of procedures; medicines and treatments, what the physician and the pharmacist ask they pay just to secure their life. This in return makes the chances of fraud type vulnerable act increased. On the other hand, patient trust on the doctor’s for the payment and is not even aware where the money is been used. This also increases the chance of fraud in US(Fisher,
In some instances, the pharmaceutical industry in the United States misleads both the public and medical professionals by participating in acts of both deceptive marketing practices and bribery, and therefore does not act within the best interests of the consumers. In America today, many people are in need of medical help. In fact,the Federal Trade Commission estimates that 75% of the population complain of physical problems (Federal Trade Commission 9). They complain, for example, of fatigue, colds, headaches, and countless other "ailments." When these symptoms strike, 65% purchase over-the-counter, or OTC, drugs.
The United States of America accounts for only 5% of the world’s population, yet as a nation, we devour over 50% of the world’s pharmaceutical medication and around 80% of the world’s prescription narcotics (American Addict). The increasing demand for prescription medication in America has evoked a national health crisis in which the government and big business benefit at the expense of the American public.
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).”
Regardless of technological advancement, life-saving skills and abilities and first-world resources, the outlandish cost of healthcare in the United States far surpasses any other country in the world. From price gouging, to double billing, to overbilling, to inefficient and expensive operations, the United States wastes $750 billion every year through our healthcare system. According to the Institute of Medicine (IOM), $200 billion of that astronomical number is due to nothing more than administrative waste. It is estimated that 15 cents of every dollar spent on healthcare is wasted due to inefficient administrative practices.
One of the biggest contributors to health care costs that I have seen during my time in the healthcare industry is insurance fraud. One example of such fraud came about two months ago. I was taking a phone call from a provider that was upset that one of their claims had denied even though all of their previous claims had been paid. In researching with a partner plan it was determined that the claim denied because this medical provid...
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,
An issue that is widely discussed and debated concerning the United States’ economy is our health care system. The health care system in the United States is not public, meaning that the states does not offer free or affordable health care service. In Canada, France and Great Britain, for example, the government funds health care through taxes. The United States, on the other hand, opted for another direction and passed the burden of health care spending on individual consumers as well as employers and insurers. In July 2006, the issue was transparency: should the American people know the price of the health care service they use and the results doctors and hospitals achieve? The Wall Street Journal article revealed that “U.S. hospitals, most of them nonprofit, charged un-insured patients prices that vastly exceeded those they charged their insured patients. Driving their un-insured patients into bankruptcy." (p. B1) The most expensive health care system in the world is that of America. I will talk about the health insurance in U.S., the health care in other countries, Jeremy Bentham and John Stuart Mill, and my solution to this problem.
Third is performing reckonable accident errors that have been impaired on patients whereas the amount also was listed at $1.7 Million from 2008.Fourth the U.S. reckless spends about 100-200 billion a year in curing uninsured patients. Fifth, the most commonly talked about drug of all is tobacco, which amounts to about 96 billion. Healthcare not only does give patients the importance of everything but we also have technology along with so many life-enhancing benefits is ridiculously high and is way over the line. Which is why so many of our medical learners are not being trained enough to understand the importance of procuring and delivering prescription drugs that have cost about 1.3 billion dollars. The Question we should ask ourselves this how is it going to look when those are in need of a serious medical issue of having what’s required of them to take in order to ease their pain.
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.
Medicare fraud occurs when healthcare providers, suppliers, and private companies charge for services or supplies patients never receive. Additionally, abuse of the Medicare program also occurs because physicians and suppliers do not always follow best medical practices which leads to excessive costs through improper payments, or medically unnecessary services, both of which abuse the program. Conservative estimates suggest he...
According to Roy, 2013 the issues of providing the affordable care act will unite both the supporters and offenders of the public policy, but in this current situation where the input costs are rising, it will become impossible for government in managing the public policy related to affordable health care. In order to provide affordable health care, majority of the US government has tried out different policies time to time, but unable to get success in realizing the actual policy goals. By providing the affordable health care to majority of the people who requires more amount as controlling the input cost is not possible (AAMC, 2013). Lack of doctors is one of the primary issue in providing high quality health care to the citizens especially those who are financially poor. The Supreme Court of the country passed an Act related to Health insurance as all should have Health Insurance to all the country people by the year 2014, but the at the same time government is concerned about constitutionality of these act (NYTimes, 2013).
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.
The early warning signs of fraud are, usually, always ignored. There are warning signs for every type of fraud out there. To understand the warning signs of fraud, we must first know what fraud is. Fraud is the intent to trick someone or lie to someone in order to receive financial gain. This definition varies depending of the type of fraud used, but the person committing the fraud is always looking for financial gain. There are many types of fraud out there. You have Medicare fraud, internet fraud, mortgage fraud, loan fraud, tax fraud, embezzlement, forgery, insurance fraud, and marriage fraud. These are only a few types of fraud. There are many more types of fraud out there and new types of fraud are being committed every day. This paper will focus on different types of fraud. The different types that will be discussed are physician identity theft, medical identity theft, corporate fraud, inventory fraud, Ponzi schemes, charity scams, miracle cure scams, and identity theft. Each type of fraud will lead into a discussion of what the fraud is, how it happens, what are the warning signs of the fraud, and what you can do to protect yourself.
America has a highly developed health care system, which is available to all people. Although it can be very complex and frustrating at times it has come a long way from the health care organizations of yesterday. Previously most health care facilities were a place where the sick were housed and cared for until death. Physicians rarely practiced in hospitals and only those who were fortunate could afford proper care at home or in private clinics.
Healthcare fraud is a crime that happens when an individual is filling out healthcare claims with the intention to earn a false profit. Health care fraud is mainly committed when a dishonest provider or consumer submits false information to obtain more profit than submitting a claim with right information and obtain the right amount of profit. For example, if an individual alters dates or alter the description of a service that would be considered fraud. Selling prescriptions is also considered fraud. If a healthcare provider or consumer is discovered with connections of healthcare fraud they will either be jailed and fined or brought to court to obtain further punishment. When a health care fraud is perpetrated, it will pass to the health