In order to insure successful and systematic reaping of the bills set out, many not-for-profit hospitals erected chillingly uncharitable collection policies. According to the Cases in Healthcare Finance textbook, “not-for-profit hospitals often intimidate and harass uninsured patients through ‘goon-like and predatory collection tactics that frequently scar the patient for life…” (Ch.5, p.238). Frightening consequences awaited patients who could not, in a restricted time period, pay their inflated bill. The insurance providers would often seize a patient’s key assets like cars or threaten to foreclose on their houses, turning a minor medical procedure into a life-collapsing nightmare. Moreover, in a WSJ article published in the early 2000’s, investigative reporters concluded that the health care providers in question “did not tell the uninsured about charity care, did not offer charity care, did not discount bills to the uninsured and aggressively pursued payment”.…
With the inception of the Patient Protection and Affordable Care Act (ACA) the Centers for Medicare & Medicaid Services (CMS) have really made even more of an effort to scale back on physician based Medicare/Medicaid fraud. These fraudulent cases come in all different manners from physicians and their practices knowingly defrauding the government to ongoing fraud which was never caught or knew they were committing fraud. Unfortunately CMS possesses little to no leniency for the infractions committed with most penalties coming in the monetary form. My task with this assignment is to break down a series of questions with specific answers as they pertain to our example and specific federal statutes (Federal Anti-Kickback Statute and Regulations,…
Along with a detailed history of insurance and political background on how has the health care system changed over the course of a few years, the book presents case studies that shows the financial strain and medical hardships caused by the declining health care system and why it is in a desperate need to reform. Some Americans cannot afford the medicine they need or cannot afford to pay the doctors for any medical help. “Hospitals try to keep out the uninsured because treating those patients will just divert hospital resources away from paying customers” (219). Some companies cannot provide insurance as an incentive with employment like previously either.…
The act of submitting fraudulent claims is nothing new; many third-party payers are often the victim of these crimes. As a working individual that pays taxes through payroll deductions, like many Americans that have a contribution towards the Medicare program. I have a right to know where funds go and how they are disbursed. The reason I chose this particular regulation because there was a similar case of an Optometrist submitted fraudulent claims to Medicare. Dr. Sponseller was sentenced to Federal Prison for 33 months for committing Medicare fraud.…
Deception in healthcare today is a controversial subject. Today’s society is that of the informed; in other words, the physician/healthcare provider-patient relationship today is that of cooperation, where the patient is fully informed and is a partner in his or her healthcare decisions. Additionally, society today is expected to be more knowledgeable and aware of their health which can most likely be attributed to the readily accessible medical information to the public through the internet and mass publication of continuous studies in the healthcare fields.…
American’s current health care system has become one of the nation’s leading controversial nuisance. The Affordable Care Act (ACA) was originally created with morals of assuring every American individual’s right to attain health care regardless of financial circumstances or pre-existing conditions along with government support if needed. Unfortunately, amongst the fabricated promises of security and assistance, this fragmented system impels families to remain uncomfortable and stressed. The additional costs and hidden fees that are woven into health insurance contracts are becoming increasingly more unbearable with every passing year. Our health plan options are seemingly appearing less like decent choices and more like mandatory commitments.…
The Affordable Care Act: Why the Premiums are Going Up, Why Insurance Companies are Backing out of it, and What Effects it has on the Economy The Affordable Health Care Act was passed in March, 2010; by former President Barack Obama. According to (Affordable Care Act-HealthCare.gov), “the act has 3 main goals, to make affordable health insurance available to more people, to expand the Medicaid program, and to support innovative medical care delivery methods designed to lower the costs of health care generally”. This research paper will discuss why the premiums are rising under the ACA, why insurance companies are backing out of the ACA, and what effects it has on our economy. The act is also referred to as “Obamacare” or “the Patient Protection…
According to S. Boyer, as many as 12.6 million adults were denied coverage by insurance companies in the year prior to her writing her blog. Some of the individuals denied coverage or were charged higher premiums included those with a history of childhood injuries, cancer that has been cured, or had been victims of domestic violence, (Boyer, 2011). The majority of the “pre-existing” illness/injuries that the insurance companies refuse to cover or were charging higher premiums for have no effect on the individual’s present health. Neither do they portray a possibility of future health related difficulties. The morality of the insurance companies for this practice is not only questionable but, points to an unethical exercise in judgment and accountability on their part.…
The United States is known to have the best medical care in the world in terms of skilled practitioners, technology advancement and treatment outcomes. However, it is also reputedly known to have the worst health care system when compared to all other developed nations. One reason for this, is that America’s medical care is exorbitantly more expensive than in other countries. Factors influencing this are the high expenses in research and development, pharmaceutical costs, technology innovation, skilled labor and high litigious environment. Another reason is the lack of optimization from insurance companies when accounting for medical expenses for all people that may or may not utilize medical services.…
After much scrutiny, The Affordable Care Act, termed “Obamacare,” finally passed through The Senate and House of Representatives, and upheld by the Supreme Court on June 28th, 2012. Through its’ passing, it caused millions of American’s healthcare insurance rates to skyrocket, and drove up insurance rates nationwide. On another note, this also opened insurance to millions of American’s who lacked any kind of health insurance at all. Throughout the country, there is evidence if we walk into doctors’ offices and try to make appointments, a lot of times we are turned away, especially if the doctors are specialists. Physicians who refuse to help Americans’ with government based insurance are detrimental to society in multiple ways.…
Americans do not need an added burden financially, as debt collectors, added stress, and uncertainty about the future could actually impede one’s ability to recover properly. In summation, the Affordable Healthcare Act undertook some of the greatest challenges facing Americans. With some success, however further case studies are needed to further understand the healthcare crisis in the United…
SECURITY CONCERN ON HIGH VOLTAGE MEDICAL RECORDS BEFORE A MOVE VITAL REQUIREMENTS OF MEDICAL RECORDS DURING A MOVE When moving medical related files, it’s necessary to know the hefty fines involved in case a privacy breach takes place. That means penalties of up to $ 1,500, according to updates on the HIPAA (Health Insurance Policy and Accountability Act.) And worst of it all, a possible publicizing of the incident in the national media, which could be detrimental to the health care facility, as well as its employees. Compacting The Identity Theft During A Moving Exercise…
In the United States many people don’t have health insurance. Health care reform is one of the top argument in our country. Most people see having a health insurance lead to a healthier life, but most of the people cannot afford it. Increasing price of doctor bills and prescription drugs causes to millions of people unable to get health coverage. People lost their jobs and houses because of the high price they have to pay for their illness.…
HealthSouth was what seemed to be an ordinary striving medical business. Some would even say it was the most successful in its field , but unlike other corporations, it had a foul secret. All the grand success that HealthSouth was known for was a lie, a mask to hide what was going on behind the scene, hidden from the public eye. A secret so well hidden, that it went unnoticed for years. A secret so large it broke not only the law but several accounting principles.…
Fraud frequently involves practices such as overcharging, billing for services not rendered, and provision of needless or unsuitable medical services, unbundling, and upcoding amongst others. While early cases of fraud during the last century were mainly limited to individual consumers or healthcare providers targeting insurance providers, fraudulent schemes have progressed with time into highly organized complex networks. The complex nature of healthcare insurance makes uncovering of fraud or abuse a substantial challenge by the pertinent authorities. According to estimates by various anti-fraud departments such as the Federal Bureau of Investigation, the Government Office and the National Healthcare Anti-Fraud Department indicate that fraud accounts for 3 to 10 % of the national healthcare spending (Smith,…