Abstract The purpose of this paper is to give an outline the fraudulent activities that take place in the healthcare world. This paper will provide information about the fraud that is ever so popular in today’s healthcare world.
Overview/Summary
Healthcare today is one of the most profitable businesses in America any many criminals are trying to take advantage of that and make a quick buck. Healthcare fraud is becoming an immense problem in today’s society. When a health care provider, health suppliers, and private health companies purposely bill Medicare or Medicaid for supplies or services that were not given it is considered healthcare fraud. For example another form of fraud is when a person uses another person’s Medicare/Medicaid card …show more content…
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, …show more content…
Consequently, congress enacted the Health Insurance Portability and Accountability Act (HIPAA) in 1996, which categorized healthcare fraud as a specific offense while making provisions for money laundering statutes. In addition, it allowed seizure of fraudulently acquired benefits and blacklisting of providers engaging in healthcare fraud (Salinger, 2005). A key objective of the HIPAA was to harmonize local, state and federal responses in combating healthcare fraud through punishment of guilty entities, deterrence of healthcare fraud and misconduct, protection of Medicare trust funds and patients and awareness creation among patients and service
Overview/Summary
Healthcare today is one of the most profitable businesses in America any many criminals are trying to take advantage of that and make a quick buck. Healthcare fraud is becoming an immense problem in today’s society. When a health care provider, health suppliers, and private health companies purposely bill Medicare or Medicaid for supplies or services that were not given it is considered healthcare fraud. For example another form of fraud is when a person uses another person’s Medicare/Medicaid card …show more content…
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, …show more content…
Consequently, congress enacted the Health Insurance Portability and Accountability Act (HIPAA) in 1996, which categorized healthcare fraud as a specific offense while making provisions for money laundering statutes. In addition, it allowed seizure of fraudulently acquired benefits and blacklisting of providers engaging in healthcare fraud (Salinger, 2005). A key objective of the HIPAA was to harmonize local, state and federal responses in combating healthcare fraud through punishment of guilty entities, deterrence of healthcare fraud and misconduct, protection of Medicare trust funds and patients and awareness creation among patients and service