Show MoreMedicare fraud is becoming a huge problem in today’s society. Medicare is a health insurance program for personnel paid by taxes the American population contributes to for personnel 65 years or older. When a health care provider, health suppliers, and private health companies deliberately bill Medicare for supplies or services that were not given is considered Medicare Fraud. To include, when a person uses another person’s Medicare card to receive health care for which the person does not qualify for. An individual, company, or a group can commit a Medicare fraud scheme.
Medicare Fraud Scheme
A physician, office manager for the physician’s medical practice, and five owners of health care agencies were arrested for charges related to the…show more content…
Affects of Medicare Fraud Medicare fraud affects everyone indirectly. Fraud causes increased costs for patrons, tax payers, health insurance plans, and degrades the integrity of the health care system and legitimate patient care. The fraud can take money away from the Medicare program and leave less available funds for participants or can increase taxes to cover the remainder costs. Directly the fraud affects the patients in which the physicians have made the fraudulent claim on behalf of by copayments made for services never received.
Prevent Health Care Fraud Medicare fraud can be prevented by the following:
• When a health care service has taken place, record the dates.
• Save receipts and statements from providers and check for any inaccuracies. o Compare this information with the Medicare claim processed to ensure no extra charges are annotated.
• Guard Medicare and Social Security Numbers (SSN)
• Do not give medical number or SSN for free medical equipment or services.
Government Prevention The government is also helping to prevent and catch those responsible for Health Care Fraud by the 2009 creation of the Health Care Fraud Prevention and Enforcement Action Team (HEAT). Heats mission is to gather resources across government to help prevent waste, fraud and abuse in the Medicare and Medicaid programs, and crack down on the fraud perpetrators who are abusing the system and costing us all billions of dollars, reduce skyrocketing
Health Care Fraud Essay
1823 Words8 Pages
Summary and Conclusion
This study sought to answer three research questions. Although the questions have been presented in previous chapters, they are worth presenting again.
What are the major federal laws and policies related to health care fraud?
How have these laws and policies been used to control fraud, waste, and abuse in federal health care programs?
• What are the impacts of these laws and policies on the war against health care fraud?
To address the questions comprehensively, the researcher conducted a historical research that blended the research elements of documentary research and content analysis. The use of historical research provided opportunity to travel through time and trace the origin and evolution of…show more content…
After establishing Medicare and Medicaid in 1965, Congress saw the need to protect the programs from fraudulent activities and practices of unscrupulous providers. The laws on health care fraud were enacted at different time during the history of the health care programs. However, the overall congressional intent has been the same, and the objective is to strengthen existing laws to protect the federal government health care programs from fraudulent activities. Although Congress has used several anti-fraud measures to protect the federal government health care programs, the False Claims Act of 1986 has become the main weapon that government prosecutors use against perpetrators of health care fraud. Designed to prevent fraud and other abuses in federal government programs, the False Claims Act has been the primary statute the government has used in its fight against health care fraud. However, government prosecutors do not rely on one statute in their prosecution of alleged cases of health care fraud. Instead, they rely on a combination of statutes, but the False Claims Act has emerged as the main statutory weapon.
Congress had amended the Medicare and Medicaid laws severally since their enactment in 1965. The Medicare-Medicaid Anti-Fraud and Abuse Amendments of 1977 were the first significant policy initiative Congress took to prevent fraud and abuse from Medicare and Medicaid. The 1977 amendments were specifically designed to