HEALTH CARE FRAUD

Health Care Fraud

Health Care Fraud

Introduction

Fraud is defined as a deliberate dishonesty or distortion committed by an individual, that effects in some unlawful gain to him/herself or to someone else. According to research, the health care industry is more exposed to scam than any other industry (Fisher 2008). The health care fraud comes into existence because of the increasing health care cost. Health care deception is seen as an abuse on health care resources (www.valueoptions.com). Due to health care fraud, U.S is facing a huge amount of loss every year. Because health care fraud has played such a very important role in raising the cost of health care it has gained a lot of consideration from the government and the United States people (Caldwell 1997).

Discussion

As discussed above, the health care fraud is on the rise because of the increasing medical cost or health care cost. The U.S government has spent the last decade, focusing on investigating health care frauds with the aim of decreasing its occurrence (Fisher 2008). There are numerous numbers of medical frauds committed by the medical representative or physicians in order to gain financial benefits from their industry. The most commonly practiced frauds are as follows.

Upcoding

This is the widely practiced mean of medical fraud. Coding a service at a higher level than what was rendered is known as upcoding. The medical representative or the physicians charge higher from the patient then the actual medication. According to the research, majority of individuals have health insurance from government or any other private institutions. This means that the patient expense is being paid by the third party. The physicians and doctors take advantage from this act. Due to the lack of customer knowledge in medical diagnosis and medicines, the doctors diagnose a relatively expensive treatment for a very ...