Ethical and legal Implications - Essay Example

Without a doubt, ethical issues in the financial services industry continue to be the critical point of discussion for the healthcare industry. Ethical issues in the financial services market affect everyone at the macro level. The financial market is quite huge itself as it comprises of large banks, securities entities, insurance companies and mutual funds. One of the critical institutions that is the focal point in this scope are the insurance companies. Conducive research indicates that four billion healthcare claims are submitted annually.

Even though a small portion of is submitted through fraud, the estimated loss in these fraudulent activities can result up to a hefty $56.7 in losses. This can be detrimental as Medicare will be a huge issue around 2033. In order to combat fraud, Congress enacted HIPPA and the ACA have implemented some procedures to combat fraud. The HIPAA and ACA are both critical legislations that ensure patient privacy. This is a key element to prevent fraud in most cases. Individuals seeking information must submit their PHI or SHI in order to prevent other individuals from claiming insurance compensation on behalf of others.

Clearly, preventing fraud should be a top priority for insurance companies for various reasons. Even though it is almost to estimate the cost of fraudulent claims, taxpayers have to atone for the financial woes as their tax money is utilized. The worse aspect in this whole scenario is the fact that money lost to improper financial billing can be used to support lower income individuals. The lower income individuals instead have to suffer as a result of fraudulent claims.Most criminals think that committing fraud is a victimless crime based on a contrary belief that healthcare providers make insane amounts of money.

Although this may true, one cannot ignore the fact that when healthcare providers lose money, it totally takes a toll on the Medicare programs. Healthcare providers often have to bid on programs from the government and reimburse their patients. In essence, committing fraud is a huge burden as it not only diminishes the amount of money in Medicare; it also forces insurance providers to compensate for their unnecessary loses. Hence, both the government and insurance providers have embedded compliance governance and auditing programs in their organization structure.

Blue Cross Blue Shield of America is one of the most prominent healthcare providers that have spearheaded this effort. This organization has implemented a strong foundation of auditing and continues to work closely with legal governance. Furthermore, it has implemented a close relationship with the government with budget for the 2014 healthcare reform. In order to ensure the privacy of its patients, all employees at Blue Cross Blue Shield of America must undergo severe training. Corporate laws are strict in sharing information.

As far as whistle blowing is concerned, the company has enforced a solid foundation of remaining anonymous if the legal protocols are not being followed. Any personnel attempting to commit fraud are morally responsible for their actions and will be obligated to answer to the head executives. The company also conducts “brown bag sessions” in which auditors must meet their annual requirements of maintaining their CISSA certificates. Lastly, all interns at this company are required to attend actuarial information sessions in which HMO is discussed along with government involvement.

Works Cited1993 Medicare part B provider handbook for Illinois: coverage, billing, reimbursement.. Marion, Ill.: Blue Cross and Blue Shield of Illinois, 1993. Print."What is HIPAA." What is HIPAA. N.p., n.d. Web. 18 Aug. 2011. .