Module 5: Health Care Fraud Control
Fraudulent health care practices by medical professionals and other criminals of defrauding insurance companies and consumers are on the rise. According the Federal Bureau of Investigation (FBI) (2015), these dishonest practitioners are increasingly willing to risk patient harm to further their criminal activities. The FBI is the primary agency for exposing and investigating all federal and private insurance health care fraud cases. Furthermore, the agency maintains jurisdiction over all cases of fraud. Although the criminals continue in their deceptive ways, the Department of Human Services (HHS) (2015) reports the government has recovered a record high recovery of $10.7 billion in health care fraud. The …show more content…
Although the primary verbiage speaks to combating fraud in the the housing and mortgage arena, the act amends the federal criminal code to include appropriations to the Attorney General to investigate and prosecute false or fraudelent claims for payment by the federal governement. This includes defrauding both Medicare and Medicaid programs and expands the False Claims Act (FCA) (Congress, 2009). The bill received support from the Obama Administration, the FBI, and the OIG, although there is some debate whether an organization must knowingly retain improper payments as opposed to the Senate’s wording stating merely acceptance of overpayment imposes liability. It is believed by member of Congress that FERA will bring the United States closer to prosecuting individuals who have defrauded the government and harmed the United States economy (Cimasi, Zigrang, & Sharamitaro, 2009). Both FERA and the expanded provisions of the ACA are hopeful legislation to deter fraud, as well as broaden powers to apprehend and prosecute …show more content…
The ACA includes additional provisions giving the government much stronger oversight abilities, thus aiding them in prosecuting those breaking the law. In contrast, FERA amends the criminal code, giving the Attorney General the ability to investigae and prosecute individuals seeking to commit Medicare and Medicaid fraudelent billing of any kind. It speaks volumes the new legislation has allowed the government to recover billions since the passage of these laws. Although compliance is complicated, an ethical practitioner has a mutltitude of assistance from numerous sources to understand and comply with the law. Ultimately, the government and the public depend on trustworthy relationships with physicians to care for all residents of the United
Fraudulent health care practices by medical professionals and other criminals of defrauding insurance companies and consumers are on the rise. According the Federal Bureau of Investigation (FBI) (2015), these dishonest practitioners are increasingly willing to risk patient harm to further their criminal activities. The FBI is the primary agency for exposing and investigating all federal and private insurance health care fraud cases. Furthermore, the agency maintains jurisdiction over all cases of fraud. Although the criminals continue in their deceptive ways, the Department of Human Services (HHS) (2015) reports the government has recovered a record high recovery of $10.7 billion in health care fraud. The …show more content…
Although the primary verbiage speaks to combating fraud in the the housing and mortgage arena, the act amends the federal criminal code to include appropriations to the Attorney General to investigate and prosecute false or fraudelent claims for payment by the federal governement. This includes defrauding both Medicare and Medicaid programs and expands the False Claims Act (FCA) (Congress, 2009). The bill received support from the Obama Administration, the FBI, and the OIG, although there is some debate whether an organization must knowingly retain improper payments as opposed to the Senate’s wording stating merely acceptance of overpayment imposes liability. It is believed by member of Congress that FERA will bring the United States closer to prosecuting individuals who have defrauded the government and harmed the United States economy (Cimasi, Zigrang, & Sharamitaro, 2009). Both FERA and the expanded provisions of the ACA are hopeful legislation to deter fraud, as well as broaden powers to apprehend and prosecute …show more content…
The ACA includes additional provisions giving the government much stronger oversight abilities, thus aiding them in prosecuting those breaking the law. In contrast, FERA amends the criminal code, giving the Attorney General the ability to investigae and prosecute individuals seeking to commit Medicare and Medicaid fraudelent billing of any kind. It speaks volumes the new legislation has allowed the government to recover billions since the passage of these laws. Although compliance is complicated, an ethical practitioner has a mutltitude of assistance from numerous sources to understand and comply with the law. Ultimately, the government and the public depend on trustworthy relationships with physicians to care for all residents of the United