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Health Care Fraud - Essay Example

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An author of the following assignment intends to represent a detailed discussion about the problem of the healthcare fraud, describing different aspects and issues regarding such topic. Additionally, the paper shall look at the influence of the reforms on the problem…
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Health Care Fraud
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Download file to see previous pages hat around 10% of the federal health care budget is lost to fraud (Krause) as doctors and healthcare providers form an integral part in many of these frauds. It has been recorded that US healthcare system wastes something between USD 505 billion and USD 850 billion every year and over 20% of this sum is from the fradulent practices like kickbacks to the doctors and unethical insurance practices (Kelland). Since these frauds enhance the healthcare costs to such an extent that it has compelled the policymakers in the government to dedicate due attention to them. In order to enhance the understanding on the topic, this research paper throws light on health care frauds, their types and the role of enforcement agencies in the American context. Figure 2. Projected Medicare and Medicaid Spending & Estimated Fraud (2005-2015) Figure Source: Ted Doyle, Director, Etico llc Since GAO and NHCAA frauds amounts tend to be a fixed percentage of Medicare and Medicaid spening, future growth in government funded healthcare would imply a high risk of health care frauds, unless stringent enforcement measures are adopted. . Defining Fraud Fraud: Practitioners and academicians have defined fraud from numerous perspectives, in order to have a clarity about fraud, the following definitions of fraud as defined in health care context were retreived from the published literature:, “fraud is an intentional deception or misrepresentation that someone makes, knowing it is false, that could result in the payment of unauthorised benefits.” …..by HFCA (Torras) Federal Legislation (Cornell universilty Law School) describes a person who files in an false claim as: “…. Including any person who engages in a pattern or practice of presenting or causing to be presented a claim for an item or...
The figures pertaining to health care fraud are so staggering that around 10% of the federal health care budget is lost to fraud as doctors and healthcare providers form an integral part in many of these frauds. It has been recorded that US healthcare system wastes something between USD 505 billion and USD 850 billion every year and over 20% of this sum is from the fradulent practices like kickbacks to the doctors and unethical insurance practices. Since these frauds enhance the healthcare costs to such an extent that it has compelled the policymakers in the government to dedicate due attention to them. In order to enhance the understanding on the topic, this research paper throws light on health care frauds, their types.
Since GAO and NHCAA frauds amounts tend to be a fixed percentage of Medicare and Medicaid spening, future growth in government funded healthcare would imply a high risk of
health care frauds, unless stringent enforcement measures are adopted.
Practitioners and academicians have defined fraud from numerous perspectives, in order to have a clarity about fraud, the following definitions of fraud as defined in health care context were retreived from the published literature:,
“fraud is an intentional deception or misrepresentation that someone makes, knowing it is false, that could result in the payment of unauthorised benefits.” …..by HFCA
Upon a closer look at various definitions, it is clear that the fraud is based on the intent of the one who commits it ...Download file to see next pages Read More
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