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Healthcare Fraud And Abuse In Health Care

807 Words4 Pages

Health Care Fraud and Abuse Health care quality designates a set of values that have to be met by healthcare providers as determined by various standards. Such standards examine whether healthcare services are of suitable quality to patients. The resultant outcome of any healthcare service provided by health practitioners ranging from the technical performance to interpersonal relationships depends on quality of the services. Healthcare fraud and abuse are some of the issues affecting the quality of healthcare services. According to the Blue Cross Blue Shield Association (2016), healthcare fraud is a felony in various states regulations that can occur in the form of deceits inside the healthcare systems purposively for illicit growth. On the …show more content…

This menace is characterized by high costs for employers and consumers because of the increased expenses and inefficiency (DHHS, 2014). As a result, patients are frequently exposed to unnecessary procedures. The methods used in fraud vary as those involved are in search of new approaches to outwit the bylaws. Every citizen pays the price of healthcare fraud, therefore, reduced health scheme benefits and treatment to meet the increased costs. The available evidence suggests that that every family in the US pays above $ 800 additional costs yearly due to fraud (Blue Cross Blue Shield Association, 2016). It is for this reason that this research becomes necessary to unearth the underlying fraud and abuse-related issues within healthcare. The paper explores the different types of frauds and abuse in the health sector. In addition, it discusses the impact of fraud and abuse on the American community, as well as possible solutions. Literature Review This section discusses the various types of frauds. These include upcoding, identity theft, billing of unnecessary services and overcharging of simple services offered by health care providers. Further, it highlights the consequences of fraud and abuse on community and ways of solving the issues to reduce the burden of the associated costs on citizens. …show more content…

One of the common forms of healthcare fraud under discussion is the unnecessary billing of items or services. This is a fraudulent act committed by filling a claim that does not apply to a patient’s conditions. A case in point is the billing of an echocardiogram for a patient with eye problems. Such kinds of unnecessary exploitation of healthcare services have to be safeguarded under the Social Security Act. The Act provides the procedures and guidelines on the payments of search services (DHHS & Department of Justice,

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