Reinforcement of Federal Health Care Penalties

Doctors need to be better trained and aware of how not to commit healthcare fraud. They should be evaluated every five to ten years on their work and the practices they use.

Another form of healthcare fraud is upcoding. Upcoding is defined as: “refers to situations where providers bill for services that are more expensive then the services that were actually provided.” (Payne,2013) Upcoding is a major problem because offices are receiving large payments for services that weren’t worth half of what they received payment for. This is a type of fraud because the doctors are charging the patients insurance companies for more money than the treatment that the patient received. Most Patients never go in depth about what their insurance companies are being charged because they figure that the insurance companies will handle the expenses and they will pay the remaining amount out of pocket.

Another example of Healthcare fraud is Fraud by Pharmacist. Many people. May think that there is no way that a Pharmacist can commit fraud. It is easier than you think. A pharmacist can get a prescription note written by a doctor for a patient and they can say that they misinterpreted the three for a five or something in that nature. Ultimately, what they do is request more medicine than what is required and they either take it home or stash it in a place that only they will know that it is there. According to the article, Compounding Fraud Scheme: Pharmacies in Tampa and Miami were working with eight men from within the area to commit Pharmacy Fraud. “The pharmacies submitted approximately $633 million in claims for prescription compounded medications and received approximately $157 million in reimbursement based on the claims.” (Mena Report, 2016)

 

There are many changes that can be made to correct and overall deter healthcare fraud. Healthcare fraud didn’t begin with one person and it will not end by being stopped by one person. Overall, I think doctors and Pharmacist and everyone in the medical field need better training and education on fraud being committed in the healthcare system. Some people may not know they are committing fraud until they are too far gone and don’t know how to control it and they don’t know how to stop or don’t want to stop. A pharmacist or doctor is not going to know how to commit fraud or do fraudulent things unless they are shown or taught how to.

According to the article Health Care Fraud and Abuse, “One of the most effective ways of controlling fraud and abuse is through reinforcement of federal penalties.” (Rudman, 2009)

I think that statement is very true because if a person knows that if they are caught doing fraudulent things and know that there are federal consequences for the fraudulent behavior they will be less likely to commit Healthcare Fraud. Aside from training and education I think that is the most effective way to stop Fraud in the Healthcare system. Also stated in the article, “During 1988 and 2000, the federal government recovered slightly over $1.8 billion from healthcare providers who committed fraud.” (Rudman,2009) Healthcare fraud has been going on for years and people are caught committing fraud all of the time. I think once you get the government and federal people involved then people become scared and stop committing fraud.

When people know that there are consequences and strict laws against a crime they are less likely to commit the crime. But if they see others getting away with it and not being caught then they think that they will be okay to do it also. If there are televised and new stories about people being punished for committing healthcare fraud I think then people will see the real harm in the situation. Overall, I think with better Training and understanding of Fraud and the harm that it does to not only the insurance companies and the patients also the doctor offices and employees involved. People will be better educated and encourage others not to commit fraud. I also think that there should be televised and printed awareness seminars and rallies against Fraud in the Healthcare System. The more people are aware the less it will transpire and the consequences need to be fair and strict.

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