Frauds and Abuse in Healthcare

Abstract

This paper intends to conduct a thorough study of the Healthcare Frauds and Abuses in the United States of America. It is observed that the health care programs of the United States are greatly involved in committing the fraudulent acts, thus affecting the whole nation. The False Claims Act of 1986 proves to be effective in avoiding these frauds existence at a large level. The criminal negligence is also considered in the field of health care programs considering law governing agencies.

Abstractii

Introduction1

Discussion2

ICD-9-CM2

Current Procedural Terminology (CPT)3

Solutions to Fraud and Abuse3

The need of the False Claims Act of 19864

Enactment of FCA6

Effects of Frauds8

Criminal Negligence9

Conclusion11

References13

Fraud and Abuse in Healthcare

Introduction

The Health Care of the United States of America is supposed to be the best in the world but actually it is the country that does not have even a universal health insurance system. It provides free medical technology and advanced services all over the country, but still it is found inefficient in providing high quality services to people without meeting administrative waste.

The healthcare department is also involved in the fraudulent activities that disrupt the overall image of the department in everyone's eye. None can rely on the treatment facilities and services if there will be any doubt regarding the performance of the medical staff and the authorities. Frauds in healthcare are the deliberate deceits by falsification of the facts to get benefited in terms of money. It may include the false claims of improper service provision, and providing the false medical reports to people just for money. The responsible persons are also found to be involved in the fake representation of the details of the services utilized as per the requirement of the people who pat them for this purpose. This includes even the high amount reception for the average cost services. These frauds also encompass false eligibility in the field of healthcare without providing insurance to the masses.

The healthcare authorities are also unable to eliminate the abusing activities in the departmental services. Even the professionals are performing inappropriate tasks within the field. The patients and the common people suffer inadequacy in appropriate billing services, refusal in gaining access to the medical records, and even misguiding the people regarding the medical services need. They are also failed in maintaining records of finance and the medical services provided to the patients.

Discussion

A number of healthcare programs are running in different areas of the country for providing good quality services to all the people. Mostly, these programs are not running under honest leads as there are fraudulent schemes executed intentionally to disrupt the services' performance. Similarly, the conflicting nature of the medical practices also leads to the abuses of healthcare. It is an unintentional act which is committed by the staff and administration in providing quantitative services to the people.

ICD-9-CM

It is an acronym for “International Classification of Diseases-Ninth Revision-Clinical Modification”. It is responsible for assigning and revising the codes associated to the medical services provided in the hospitals of United ...