Fraud And The Health Care Fraud Essay - 2583 Words

On November 21, 2013, Theanna Khou pleaded guilty to dispensing and selling OxyContin from his Huntington Pharmacy without medical necessity from fraudulent prescriptions issued by a clinic ( Health care fraud investigations, 2014). Khou billed Medicare for filling prescriptions that patients never received. This story is becoming a norm for the health care industry, because the growing financial prosperity of the health industry. Corruption and crime is changing, turning from drug dealing to a safer haven that has less legal management, organization, and more wherewithal the business of health care fraud. Health Care Fraud Fraudulent misrepresentation (fraud) is defined as the intentional deceit for personal gain (Clarkson, Miller, Cross, 2012). Fraud occurs when a person knowingly represents an intentional deception as a fact to gain benefits they are not entitled. The boundaries between fraud and abuse seem to be confused; the degree of intent distinguishes fraud from abuse. Under HIPAA, it is considered a felony to intentionally implement a scheme to â€Å"defraud any health care benefit program or to obtain money or other property owned or controlled by a health care benefit program by means of false or fraudulent pretenses, representations, or promises† (Shepard, 2004, para. 1). Health care fraud is an intentional act to deceive in order to receive greater reimbursement for services, whereas health care abuse is conduct which is not consistent with acceptableShow MoreRelatedHealth Care Fraud Is A Crime1479 Words   |  6 Pages Health care fraud comes from many aspec ts. Fraud comes from some type of abuse to the system. Such abuse can come from billers, providers and or patients. Abuse of the system can turn into fraud. Because the fraud can come from many angles, it makes it really difficult for regulatory agencies to detect and protect against abuse and fraud. However, many changes to the system and the collaboration of regulations by many agencies have made a difference. Health care fraud is a crime that over timeRead MoreHealth Care Fraud Essay1823 Words   |  8 Pagesquestions have been presented in previous chapters, they are worth presenting again. ï‚ § What are the major federal laws and policies related to health care fraud? ï‚ § 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 documentaryRead MoreHealth Care Fraud and Abuse1918 Words   |  8 Pages| | |Health Care Fraud and Abuse | | | | Read MoreThe Common Types Of Health Care Fraud1231 Words   |  5 Pages 1) What is the HIPPA definition of fraud? Give an example of fraud. a. The HIPPA definition of fraud is: i. â€Å"Knowingly, and willfully executes or attempts to execute a scheme...to defraud any healthcare benefit program or to obtain by means of false or fraudulent pretenses, representations, or promises any of the money or property owned by...any healthcare benefit program†. ii. One of the most common types of health care fraud occurs when there is a misrepresentation of provided services, due toRead MoreHealth Care Fraud Enforcement Arsenal1509 Words   |  7 Pagespowerful tools in the government’s health care fraud enforcement arsenal (Mattie, A., Rosalyn Ben-Chitrit. (2009).).† Any healthcare organization could face â€Å"Civil damages under the FCA, which are substantial. Penalties can be monetary and programmatic, which can have significant impact on a healthcare organization of any size. According to the law, the government may recover up to three times the amount of damages it sustained as a result of the defendant s fraud plus $5, 500-$11,000 per fraudulentRead MoreEssay about Health Care Fraud2076 Words   |  9 PagesHealth Care Fraud: The typically overlooked crime of healthcare fraud has resulted in a significant monetary loss on the part of the American public paying into government run medical programs, as well as private insurance company programs. Historically, we have seen that in any instance where money is involved people have found ways to or at least have attempted to obtain it illegally. Some do it through overt acts of violence such as a robbery. Others choose more covert ways of illegally obtainingRead MoreAnalyze a Contemporary Health Care Issue1036 Words   |  5 PagesIntroduction to Health Care Finance (HCA 240) Analyze Contemporary Health Care Issue According to the Federal Bureau of Investigation (FBI) â€Å"health care fraud costs the country an estimated $80 billion dollars a year† (Health Care Fraud, n.d., p. 1). Because health care costs continue to rise more rapidly than the rate of inflation the threat of health care fraud continues to rise. The Affordable Health Care Act has put new policies in place to identify and stop health care fraud. The FBI alongRead MoreMedicaid Fraud1530 Words   |  7 PagesMedicaid Fraud HCS/545 July 9, 2012 Medicaid fraud comes in many forms. A provider who bills Medicaid for services that he or she does not provide is committing fraud. Overstating the level of care provided to patients and altering patient records to conceal the deception is fraud. Recipients also commit fraud by failing to report or misrepresenting income, household members, residence, or private health insurance. Facilities have also been known to commit Medicaid fraud through false billingRead MoreHEALTHCARE857 Words   |  4 Pagesï » ¿HEALTHCARE FRAUD Abuse AND Prevention Health care fraud is a crime. Fraud is committed when a provider or patient intentionally submits false or misleading information to a health plan for use in determining the amount of health care benefits payable. As a Group Health member, there are steps you can take to prevent health care fraud and to report suspected fraud and abuse. There are a lot of things people can do to prevent Healthcare fraud some things that can be done Start by knowing your benefits