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Health Care Fraud Case Study

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Health Care Fraud (18 US Code 1347)

The Health Insurance Portability and Accountability Act, also known as (HIPAA) was passed by the United States Congress, on August 21st, 1996. Which provides data privacy and security provisions for protecting medical information. The five sections, or titles act, was signed by President Bill Clinton. Due to concerns of health care fraud, “While the Federal False Claims Act provides CMS with regulatory authority to enforce fraud and abuse statutes for the Medicare program, HIPAA extends that authority to all federal and state healthcare Programs”. (Green & Rowell, 2013) The five sections of HIPAA are:
Title I -- Health Care Access, Portability, and Renewability.
Title II -- Preventing Health Care Fraud and Abuse, Administrative Simplification, and Medical Liability Reform.
Title III -- Tax-Related Health Provisions.
Title IV -- Application and Enforcement of Group Health Plan Requirements.
Title V -- Revenue Offsets. (Green & Rowell, 2013) All five sections, play an important part in preventing healthcare and Medicare fraud. According to the HIPAA Act, Fraud is defined as “an intentional deception or misrepresentation that someone makes, knowing it is …show more content…

T. (1999). Insurance Handbook for the Medical Office (6th ed.). Philadelphia: W B Saunders Co; 6th edition.
Fraud, C. A. (2017, April 15). By the numbers: fraud statistics. Retrieved from Coalition Against Insurance Fraud: http://www.insurancefraud.org/index.htm
Green, M. A., & Rowell, J. C. (2013). Understanding Health Insurance A Guide to Billing and Reimbursement (Eleventh ed.). Clifton Park: Delmar Cengage Learning; 11 edition.
Sanborn, B. J. (2017, March 28). Texas doctor convicted in $40 million Medicare home health fraud, faces decades in prison. (B. J. Sanborn, Ed.) Retrieved from Healthcare Finance News:

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