A significant portion of spending and high costs on healthcare stems from waste. Waste is “defined as healthcare spending that can be eliminated without reducing the quality of care” (Patel & Rushefsky, 2014, p. 269). There are several causes of waste, such as misuse, overuse, and underuse of medical services; uncoordinated care, failure to implement coordinated care, complex administrate procedures (Patel & Rushefsky, 2014, p. 270). Annually, waste costs $700 billion (Patel & Rushefsky, 2014, p. 271). Another fraction of healthcare spending results from fraud and abuse. These “are situations in which reimbursement claims are made by providers to third-party payers for services that are not provided and include providers receiving” (Patel & Rushefsky, 2014, p. 270).
The complexity of Medicare and Medicaid programs causes them to be susceptible to both fraud and waste (Patel & Rushefsky, 2014, p. 270). There have been healthcare providers who have billed for services they had not conducted and prescribed unnecessary services. Aggressive efforts, such as the Health Care Fraud and Abuse Control Program was established to control fraud (Patel & Rushefsky, 2014, p. 270). The program successfully, allowed the government to negotiate $605 million …show more content…
Prior to establishing enforcing mailing standards, patients will need to be aware of potential fraud and how to spot it; and learn how to interpret their bills correctly. This can be accomplished in an educational setting that is made apart of eligibility requirements to receive Medicare and Medicaid benefits. Preventative actions are the key to reducing the effects of fraud and waste on healthcare costs.
Patel, Kant; Rushefsky, Mark E (2014-12-18). Healthcare Politics and Policy in America: 2014 (p. 271). Taylor and
The complexity of Medicare and Medicaid programs causes them to be susceptible to both fraud and waste (Patel & Rushefsky, 2014, p. 270). There have been healthcare providers who have billed for services they had not conducted and prescribed unnecessary services. Aggressive efforts, such as the Health Care Fraud and Abuse Control Program was established to control fraud (Patel & Rushefsky, 2014, p. 270). The program successfully, allowed the government to negotiate $605 million …show more content…
Prior to establishing enforcing mailing standards, patients will need to be aware of potential fraud and how to spot it; and learn how to interpret their bills correctly. This can be accomplished in an educational setting that is made apart of eligibility requirements to receive Medicare and Medicaid benefits. Preventative actions are the key to reducing the effects of fraud and waste on healthcare costs.
Patel, Kant; Rushefsky, Mark E (2014-12-18). Healthcare Politics and Policy in America: 2014 (p. 271). Taylor and