Dealing with Fraud

Dealing with Fraud

Introduction

The paper aims to emphasize on one of the major issues that is faced by the Healthcare industry in the United States i.e. Fraud. The impact of Healthcare Qui Tam on health care organization is provided in the paper. Furthermore, various examples and incidents are discussed to give a clear overview of the topic. Moreover, corporate integrity program in order to fight fraud in the healthcare organizations is provided in the paper as well. Fraud in the Health care sector is a significant and observable issue which is related with growing health care costs in America. A number of the other factors that add to cost; for instance, improved technology, but fraud in the health care are only seen as a drain on the resources of healthcare (Neil, 2007). Health care providers are often faced with rising costs, long return cycles and bad debts. The public demands transparency and presentations. On a survey conducted in 18 states, fraud against health insurance exists in all provinces and occurs at every stage - from collection to payment.

The management of Healthcare companies needs a solution to quickly integrate and analyze data across different hospital systems. The recently adopted administrative and legal measures should reduce the extent of fraud in the area of health care, but the efforts of United States inability to prevent the measure problem. Reducing the cost and success of the fight against fraud can be assessed only if a reliable, transparent and systematic medical and financial information. Studies conducted in recent years have shown that the total elimination of unfair minority is impossible, but with the help of a strong culture do not accept the fraud, and strong pressure from peers can maximize the number of honest majority (Rodwin, 2011).

Background

Economic crime is a serious issue affecting organizations all around the world. Despite extensive regulatory actions are taken to minimize the extent of the phenomenon. In an environment where the global economic crisis significantly increased the pressures on organizations and employees to perform well and as a result created more incentives for fraud and scammers more opportunities to their crimes. According to a global survey carried out by PwC on economic crime, losses accumulated worldwide following economic crimes are valued at tens of billions of dollars (Showalter, 2012). Moreover, 30% of the companies that participated in the survey said that they were victims of economic crime, while 42% concerned the fraud schemes were reported by workers middle. There is a constant trend of increase in fraud risk management and fraud in organizations - managing risks, led to the discovery 14% of them reported fraud schemes.

Figure 1: Who Commits Healthcare Fraud?

According to the organizations, the annual cost of health care in the world, reaching $ 5.7 trillion. Each year, more than 7% of this amount or about $ 415 billion is lost due to fraud and error, the press service of the UN. WHO experts urge countries to recognize the scale of the problem and to ...