Medicare Fraud: Ethical Issues In Health Care

Today, one of the greatest ethical issues in health care is Medicare fraud. The respected individuals who vow to protect others, find more value in sacrificing one’s health for their own personal benefit. Medicare is the federal insurance plan that provides health insurance for individuals who are 65 or older, and younger individuals who suffer from certain disabilities. Medicare fraud occurs when healthcare professionals intentionally succeed at obtaining money from the Medicare program, through unlawful and immoral endeavors. The term ‘fraud’ is used to justify that these actions are committed intentionally. Compiled data from agencies and organizations that specialize in anti-fraud and commerce show that “the estimated cost of fraud and

The immoral acts listed contradict the components of business ethics and violate basic consumer rights. The dishonesty can damage relationships with stakeholders such as employees, consumers, investors, shareholders, the media etc., and this can influence the success of hospitals, clinics, and all the associated companies.
One of the most common types of Medicare fraud is phantom billing. The name describes the action; billing of services and treatments that were never performed. For example, a patient who has just received treatment finds the cost of a medication included in the hospital bill, however that medication was never even prescribed. This type of Medicare fraud increases the costs of healthcare because money is paid for services that did not occur, and colossal sums of money are spent trying to track and prevent the fraud. According to the U.S Department of Justice, a plastic surgeon from Florida, and the clinic in which he worked were asked to pay $4 million to settle claims of billing surgeries and

Kickback fraud is when a company, usually pharmaceutical, offers ‘kickbacks’ to doctors who strongly push prescription drugs. The Barrera Law Firm further explains this; “physicians write prescriptions for drugs which have absolutely nothing to do with the patient's condition simply to take advantage of kickbacks. As well, if patients must return to the doctor month after month for a prescription refill, they profit off the charge of each office visit”(Barrera, 2017, 4). Kickback fraud demonstrates a conflict of interest, taking bribes to unfairly influence the decisions of a business solely for self-gain, because doctors will prescribe drugs despite any effects, just for money from companies. This too violates the consumer's’ right to be heard as well as their right to safety. Prescribing drugs that the patient is unaware of can have dire consequences if the patient’s health is risked. Similar to phantom billing and upcoding and unbundling, the reputation of the hospital goes down when kickback fraud is exposed. The pharmaceutical companies who provide the medications are now brought into question and the stakeholders of that business are now impacted as well. The stock of the company may decrease and thus the investors and shareholders are affected. Other buyers may stop buying and this lack of demand results in profit loss. Since the