HEALTH CARE

Health Care

Health Care

Q.1

Ans.

Injuries have historically been referred to by terms such as accidents, mishaps, casualties, acts of God, or other terms that imply a random nature or unavoidability. In fact, most injuries show clear nonrandom patterns that can be characterized epidemiologically and have identifiable risk factors (Baker, O'Neil, Ginsburg & Li, 1992). The types of injuries normally reported to law enforcement as they occur in a health care institution are:

Abrasion

Bruising

Burns

Cluster Headaches

Concussions

Congestive Heart Failure

Coronary Artery Disease

Dislocation

Flail Chest

Fracture

Injury epidemiology involves characterization of occurrences of injuries, identification of risk factors, and the evaluation of prevention programs for injuries. Although the term injury could refer to almost any adverse health event, this term is generally used to refer to damage to human tissue resulting from exposure to energy delivered in excess of the threshold that human biological systems can tolerate. This excess transfer can occur during exposure to various forms of energy, including mechanical, chemical, electrical, and ionizing and nonionizing radiation. Injuries may also occur as a result of errant medical interventions and, in the case of strangulation or drowning, could result from the lack of an element vital to the body (i.e., oxygen). Many health care experts believe that this not conflict with patient privacy expectations.

Q.2

Ans.

Fraud is similar to other types of crimes in that it involves the illegal taking of property from another. It is the method used, however, that makes it different from a crime like robbery. With fraud, there is no threat or act of violence that forces the victim to turn over property. In fact, the goal of the fraudster is often to convince the victim to relinquish property willingly. Fraud can take many forms and are usually categorized by either the method used or the target of the fraud. Some common types of fraud include health care and insurance fraud.

Like check fraud, health care fraud exacts a heavy financial toll for the U.S. Some of the more prevalent forms of health care fraud are (1) fraudulent billing schemes in health care services rendered, (2) kickbacks or inducements with the intent to influence the sale of health care, and (3) self-referrals for the purpose of financial gain. Health care fraudsters can include patients, health care providers, and billing services. The national Medicare program is one of the primary targets for health care fraudsters. Part of the problem of controlling healthcare fraud is the vulnerability of the healthcare system itself. ...