Healthcare Fraud Essay

On whitethorn 14, 2013 attorney General Eric Holder and part of wellness and man Services (HHS) Secretary Kathleen Sibelius proclaimed body politicwide take complicate by Medic be guile Strike deplume operations, in octonary cities that resulted in charges against 89 individuals, which include doctors, nurses and early(a)wise licensed wellness check professionals, for their alleged club in Medi fear phony schemes involving approximately $223 gazillion in treacherously billings. In Chicago, cardinal individuals were charged, including two doctors, with a kind of wellness c are cunning schemes. This (sixth) kingdomwide takedown targeted eight cities Miami, Houston, Los Angles, Detroit, Tampa, Brooklyn N.Y, and Chicago.On April 16, 2013, the owner, senior decision maker of Sacred Heart Hospital, along with cardinal physicians in the west side celerity were arrested for conspiring to pay and receive illegal kickbacks. The kickbacks included more than $225,000 in cash, along with other(a) forms of payment, in exchange for the referral of long-sufferings insured by Medi solicitude and Medicaid to the hospital. On Oct 19, 2012, a west suburban dermatologist, Robert Kolbusz, was indicted in U.S. District Court on four counts of wire baloney and terce counts of mail humbug.He was accused of submitting wrong claims for hundreds of patients, according to FBI officials. The Department of wellness aand Human Services cut acrossed that in pecuniary year 2011, in Illinois alone in that location were 326 Medicaid takeoff investigations, 48 were indicted on Medicaid pseud charges, 30 were convicted, 18 cases of civil settlements/judgments, and $47.8 one thousand thousand dollars was recovered in Medi manage pseudo cases. at that place are abundant news stories in the media today roughly the federal presidency enforcements against hospitals, laboratories, medical equipment suppliers, hospices, home health agencies, physicians and other health direction religious serve providers.Unfortunately, these cases are just the tip-of-the-iceberg with many health trade taradiddle cases going undetected and or unreported. According to Blacks natural natural law Dictionary fraud is defined as some deceitful practice or willful device, resorted to with in ten dollar billt to deprive other of his/ her right, or in some way to do him an injury. It is distinguished from negligence, and is always intended. health flush fraud is a pink-collar crime that usually involves filing health care claims by health care serving provider to turn a attain for the health care service providers.It involves an unlawful act, largely deception for personal gain, and encompasses a wide range of irregularities and illegal acts thatare characterized by intentional deception. (Pozgar, 2011) According to the FBI (Federal federal agency of Investigations) health care fraud in our unpolished woos an estimated $80 billion a year- maki ng it one of the biggest white-collar-crime. wellness care fraud is committed when a double-tongued provider or consumer intentionally submits or causes someone else to submit false or mis ternarying information for use in determining the amount of healthcare benefits payable. (Pozgar, 2011) health care fraud usually includes policy fraud, drug fraud and medical fraud. on that point are some(prenominal) ways by which the health care policy fraud can be committed by fraudulent health care service providers 1.) billing for run not rendered, 2.) up-coding of serve which is billing the Medicare for services that were more expensive than the ones provided, 3.) up-coding of items which is billing for more expensive items than was provided, 4.) unbundling, wherein a corrupt healthcare service provides bills that pass around over time in come out to claim more monies from Medicare, 5.) unneeded services, 6.) gemination claims- Medicare is charged twice for the same service and 7.) Kickbacks, which are rewards in cash or kind received by healthcare professionals for recommending or referring specific services for manikin referring a patient for an MRI plain when its not required.The findings from the Office of commission and Budgets fact shred Transforming and Modernizing Americas wellness attending, revealed that the United States spends approximately $8,000 per person on health care. This figure is expected to farm to approximately $4 trillion by 2017. Even the most conservative estimates of the constitute of fraud abuse within our health care arrangement range from between $66 billion and $220 billion per year. With the increase cost of health care in America, the cost of health care fraud abuse could easily rise preceding(prenominal) $400 billion per year by the year 2017. (Office of Management and Budgets fact sheet).Therefore, it is safe to say that health care fraud is not hardly an scotch drain on our health care ashes, but costs our natio n the health of its citizens (Semi-Annual Report to Congress, 2009) as it robs the system of the money that would be far repair spent on making ditch raft healthy. wellness care fraud not only costs our nation in terms of health care dollars and patient care. It is one of the important factors that has contributed to the increase cost of the health care services. delinquent to the immense role played by the healthcare fraud on the economic drain on our health care system and in like manner on the health of the nation, it is receiving a tremendous attention from both the organization and the people. Increasing cost of healthcare is a valid concern for American families and a primary concern for the American government. It affects all individuals, directly or indirectly as the billions of dollars that are upset to the healthcare fraud lead to increased health care costs and increasing the cost of potential coverage, which whitethorn further lead to loss of personal income savings ahead(p) to ruined credit. health care fraud is not a victimless crime. (Price & Norris, 2009) The money lost due to fraud increases the costs of providing a full range of legitimate medical services tremendously. Physicians may perform unnecessary procedures to increase reimbursement, which may compromise the prophylactic of the patient. Further, when medical providers bill for services that were neer rendered, they end up creating a false medical history for patients which may halter them from obtaining disability or life indemnity policies, at a later date. An outside medical history also influences preaching decisions and allows some third party insurance companies to deny coverage based on a previous medical condition. wellness care fraud also tarnishes the record of the medical profession and other health care service providers.Additionally, the efforts by the federal and the state government cost appraisepayers billions of dollars a year, thus diverting the scarce ta x money from other essential services and meeting the needs of elderly and the poor. This deflexion of the taxpayers money often results in strike downd benefit coverage, changes in eligibility for programs such as Medicaid, higher premiums for individuals or their employers, or higher copays. Health care fraud has become a primary bare for people and the government. In the last ten or so years, the government has invested a lot of effort and time on investigating health care fraud with the goal of decreasing its occurrence, and the government continues to part new policies, and create investigative bodies to guide specifically with health care fraud.Health care fraud is a vital issue for the government for a variety of reasons. Firstly, given that the government is the principal payer of health care, it is obviously concerned about how that money is spent. Secondly, health care fraud is a waste of taxpayer money. Third, it is the government which is in charge of regulating t he health care system. Last but not the least, it is the government that is entrusted with protecting its citizensfrom all sorts of criminal and crimes. Health care fraud is a grievous problem affecting every patient and consumer. The devastating situation is rooted not only in the excessive financial losses incurred, which often extends into the billions of dollars every year, but also in patient harm.The Department of Justice has declared health care fraud to be its second highest priority, interest violent crimes (Kalb, 1999). In the past fifteen years the government has spent millions of dollars struggle health care fraud. In May 2009, the HHS and Department of Justice (DOJ) collaborated to create the Health Care role player Prevention and Enforcement bodily function Team (HEAT). With the creation of HEAT, the battle against the healthcare fraud especially against Medicare and Medicaid fraud became a cabinet-level priority. The HEATS mission is to1.) converge resources acr oss the government to help continue waste, fraud, and abuse in the Medicare and Medicaid programs.2) Crack down on the people and organizations who abuse the system and cost Americans billions of dollars each year.3) Reduce health care costs and improve theatrical role of care by preventing fraudsters from preying on people with Medicare and Medicaid.4) Highlight best practices by providers and organizations use to ending waste, fraud, and abuse in Medicare.5.) march on upon the existing partnerships between HHS and DOJ to reduce fraud and recover taxpayer dollars. (HEAT Task Force Mission) In addition, to creating a task force, the judgeship also encourages ordinary citizens to report against health care fraud.There are several ways to report a healthcare fraud a patient or health care provider who may have witnessed a fraud, may report to FBI, at their local office, or hollo and or online forms. backtrack Medicare fraud website also provides various tips to citizen to prot ect themselves from healthcare fraud. Understandably, to exclusively stop healthcare fraud is a difficult task, but the more we see about it, the easier it is to stop ( gentle Cross hot Shield)ReferencesBlacks free online law dictionary Definition of Fraud. (2nd Edition) Retrieved June 13, 2013 http//thelawdictionary.org/fraud/Blue Cross Blue Shield. Healthcare Fraud Regence. Retrieved June 17, 2013 from htttp//www.regence.com/docs/legal/provider-fraud-brochure.pdf. Centersfor Medicare & Medicaid Services, Office of the Actuary. National Health Expenditure Projections 2007- 2017 Chicago Tribune, Featured Articles. Retrieved June 13, 2013 from http//articles.chicagotribune.com/2012-10-19/news/ct-tl-downers-dermatologist-charged-20121019_1_medicare-fraud-fraud-cases-medicare-medicaid-services Federal Bureau of Investigations. Healthcare Fraud. Retrieved June 14, 2013 from http//www.fbi.gov/about-us/ check out/white_collar/health-care-fraud Illinois Policy Institute. news program & Blogs. Retrieved June 14, 2013 from http//illinoispolicy.org/blog/blog.asp?ArticleSource=5746 Kalb, Paul, E. Health Care Fraud and Abuse. diary of American Medical Association 282 (1999) 1163-1168. Price. Marilyn & Norris, Donna. Health Care Fraud Physicians as snow-clad collar criminals? Journal of American academy Psychiatry Law 372869, 2009 Pozgar, George. D (2011). Legal Aspects of Healthcare Administration (11th Edition) Sudbury, MA Jones & Bartlett Learning. Semi-Annual Report to Congress October 1 2008-March 31-2009, Office of the Inspector General Stop Medicare Fraud. HEAT Task Force Mission. Retrieved June 17, 2013 from http//www.stopmedicarefraud.gov/index.html US Department of Health and Human Services. News and Press Release. Retrieved June 13, 2013 from http//www.hhs.gov/news/press/2013pres/05/20130514a.html US Department of Justice. News and Press Release. Retrieved June 13, 2013 from http//www.justice.gov/usao/iln/pr/chicago/2013/pr0416_01.html