Proper oversight and protection of whistle blowers are two methods used by organizations to prevent them falling victim to fraud. As fraud continues to occur and become more prevalent among home health agencies these type policies need to be implemented to prevent phantom billing, patient billing, up coding or unbundling schemes types of Medicare fraud. Dr. Roy and his associates we recently charged so information on their fraud scheme will continue to be released as the
* Medicare fraud occurs when medical institutions and health care providers collect reimbursement for services and medical care by fraud, including double billing, false coding, and intentionally charging for services that patients did not receive. Patients and employers are often
“Because We Can”, Reason Enough… Fertile Ground for Medical Insurance Fraud By Kenneth W. Williams Insurance in its inception was designed to further economic gains through providing security and quelling economic insecurity. By also bridging income inequality, medical insurance enabled the vast majority to lead normal lives regardless of their health disparities and conditions. Medical Insurance fraud cost U.S. residents billions of dollars every year. When health care fraud is perpetrated, the health care provider passes the costs along to the consumer/clients/customers. Because of the frequency of health care fraud, statistics now show that $.10 of every dollar spent on health care goes toward paying for fraudulent
(n.d.). Retrieved from False Claims Act attorney, Tycko & Zavareei LLP, False Claims Fraud | Tycko & Zavareei LLP: http://www.fraudfighters.net/false-claims-act-fraud/ Insurance-Fraud-Handbook.pdf (application/pdf Object). (n.d.). Retrieved from http://www.acfe.com/uploadedFiles/ACFE_Website/Content/documents/Insurance-Fraud-Handbook.pdf Ohio Attorney General Mike DeWine - Health Care Fraud FAQs. (n.d.).
“Fraud and the abuse of healthcare services in the U.S. cost an estimate $125-$175 billion annually. This represents the second largest component of the 600-850 billion surpluses in healthcare spending. Examples of fraud and abuse range from intentional misrepresentation of services that result in higher payments, billing of unperformed services, the deliberate delivery of unnecessary and inappropriate services for the express purpose of receiving the payment.”(Foster, 2012) The high cost of frauds is affecting patients because they are being exposed to unnecessary test and procedures. Because of the high cost of frauds the patients that really need help, like Mr. Davis, ends up suffering due to diminished quality of care. They also may be targeted as a people that are frauding the government because of all the medical attention they need.
In 2006 1/3 (about 29%) of claims paid by Medicare for “durable medical equipment” was incorrect for fiscal year 2006. Medicare and private health insurance companies pay nearly $16 billion a year for unnecessary tests doctors tell their patients they need. An estimated $23.7 billion in incorrect payments were made in 2007 including $10.8 billion in Medicare and $12.9 billion for Medicaid. From 2000 – 2007 478,500 claims were made and paid to dead physicians, this totaled $92 million. Improper payments to individuals, organizations, and contractors in 2009 totaled $98 billion, of that $54 billion were due to Medicare and Medicaid.
Benson as negligence. Keeping in mind the definitions of negligence, gross-negligence and malpractice, I would have to argue that Mr. Benson’s case is one of malpractice. The defining fact that Mr. Benson was injured at the hands of a medical professional makes this an issue of malpractice rather than negligence. Mr. Benson’s injury was a direct result of a medical professional failing to act in “accordance with the prevailing professional standards” (Guido, p.93). The circumstances surrounding how the incorrect extremity was amputated was not clearly identified, but the doctrine of res ipsa loquitor – “the thing speaks for itself” – can be applied in this instance (Guido, 2010).
Legal Drugs, Deadly Consequences As law-enforcement officials spend $15 billion a year combating the use and trafficking of cocaine, heroin, marijuana and other illegal narcotics, a more urgent crisis is emanating from the nation's pharmacies. According to a report from the Center for Disease Control and Prevention (CDC), overdoses from prescription drug medication have tripled in the past decade. Deaths from prescription painkillers- a class of drugs that includes hydrocodone, methadone, oxycodone and oxymorphone- have reached epidemic levels. These drugs are widely misused and abused. Every year, nearly 15,000 people die from overdoses involving these drugs.
Doctors who lack proper training or those who have impairment problems tend to believe that their patients are honest about issues concerning prescriptions. These may include certain issues such as losing prescriptions, or early refills. This, however, only happens when the doctor fails to identify a drug abuse problem in the patient. Another ethical dilemma in the same field occurs when doctors do not disclose full patient history in the medical file of the patient. This may cause other doctors to prescribe the wrong drug thus putting the life of the patient at risk, either due to possible
| HEALTH CARE FRAUD: DON’T BECOME A PART OF THE STATISTIC Professional Development 101 | Fraud takes place when a person intentionally makes a misrepresentation knowing that the deception could result in some unauthorized benefits to himself or someone else (http://www.MolinaHealthcare.com/medicaid/providers/ca/policies/pages/fraud.aspx). The most common form of fraud committed in healthcare is filing false, inaccurate claims known as health care fraud (www.MolinaHealthcare.com, et al). Making a claim to have done work other than what services and/or treatments the patient actually received is the easiest way to commit fraud and is undetectable by the medical biller or insurance company and is often referred to as phantom billing (http://www.medicalbillers.org/medical-insurance-billing-fraud/).