Healthcare Fraud

There are many crimes committed daily. Many people wouldn’t consider this specific crime to be as serious as murder or rape. Overall, it is still very important. Crimes in the Health Care System is a very serious White-Collar Crime. There are many elements with crimes in the health care system. Fraud by Doctors, Unnecessary Surgery, Medication Errors, Fraud by Pharmacists etc. The most important topic is Fraud by Doctors.

Fraud by Doctors is a very serious matter. There is a certain level of trust that you give someone who knows everything about you. It is very concerning to know that they may be sharing your personal information with others or committing fraud. According to the textbook, “The most pervasive form of Fraud committed by doctors entails the commission of Medicare and Medicaid fraud and abuse. (Payne, 2013) By using the Medicare and Medicaid as a form of fraud the Doctors are taking money from innocent people. They are making up claims and charging for visits that never happened in the end the only person that suffers is the insurance companies and the patients.

“It is estimated that between 3 and 10 percent of health care spending is lost to fraud.” (Payne, 2013) Some people are not aware that their insurance companies are being charged for visits or other things even though they may have never been seen by a doctor. In my opinion,

a great target for Doctors would be elderly patients that may not be aware of their payments and doctor bills. Elderly patients aren’t going to question their insurance company if a doctor visit mysteriously raises in price or if they get a bill in the mail for compensation for a visit that they never received.

“The Medicare and Medicaid Anti-Kickback Statue (“AKS”) is the main federal fraud law applicable to financial relationships within the healthcare market, including relationships between providers and their patients and between healthcare manufacturers and their customers.” (Krause, 2012) Kickbacks are used as way to get monetary gain from other doctors and their patients. For instance, if you schedule an appointment to see your primary care doctor for an illness. And as a result of the illness you need surgery. Your primary care doctor will refer you to a surgeon. But have you ever noticed that they won’t name multiple surgeons? They usually name one surgeon that they are aware that does the specific procedure that you need. In other words, they are more than likely in a kickback situation with the doctor that they referred you to.

Training and Education play a major role in Healthcare Fraud. For instance, when you are studying to be a doctor you may not know all of the problems that may occur along the way. Many doctors follow what they are taught in training and what they learned in their programs in college and etc. If you are trained to be a corrupt doctor or to steal from patients then that is what you will practice. “Implementation of fraud and abuse education and training programs may be facilitated through establishing corporate or staff coding committees to create standards and protocols. (e.g., standard abbreviations, documentation for medical necessity).” (Rudman,2009)

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