Fraud In Health Care

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| 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/).…show more content…
Insurance fraud to any degree is considered a felony and punishable by law (Johnson, C. 2008). Consequences for committing health care fraud are severe and based on the seriousness of the fraudulent claim as well as the number of times the same crime is committed by the same individual but each claim is considered as a separate count and is given its own sentence (http://www.criminaldefenselawyer.com/crime-penalities/federal/Insurance-Fraud.htm). Penalties include jail time on the average ranging from 1 to 16 years and very large fines ranging from $1,000 to $250,000 (www.criminaldefenselawyer.com, et al). In most cases an attorney is hired and the scammer receives a lesser sentence such as probation on the average ranging from 1 to 25 years, parole after serving a considerable and significant amount of the given sentence, restitution, and even community service (www.criminaldefenselawyer.com, et al). The penalties vary by state but can and should all be avoid by simple honesty and having a sense of…show more content…
There are serious consequences for knowing that fraud is being committed and doing nothing about it just as there are for actually committing the fraudulent activity yourself so one may want to weigh the pros and cons of being blind to a situation that they know is a crime. A biller and coder should know what fraud is and be able to recognize any given signs. A biller should always follow all steps to accurately submit claims. Personal honesty and integrity

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