Healthcare services have been on the rise for over 10 years now. According to a 2012 consumer advisory, the industry provided $2.26 trillion in payments on more than four billion claims for health insurance benefits in 2011 (health care fraud). Most complaints and most fraud and abuse stem from Medicare professionals who are knowledgeable about the process and convince new clients to provide their pertinent information in hopes of deception and illegitimate claims. Multiple and duplicate bills and fraudulent prescriptions are some of the major flaws of this organization that have brought down the healthcare services industry. (AGHAEGBUNA, 2011) This is a non-violent crime and is often committed by highly educated people including businessmen, hospitals, doctors and administrators. Multiple Billing There are numerous billing codes within the Medicare system. Many have the same codes for a medical device. If a biller attempts to submit a claim for a device, such as a wheelchair and walker, and the claim is rejected due to excessive use of that particular code due to its geographic region, the biller of the invoice can easily resubmit the request using an alternative code which will allow the case to be completed with small changes to the device (AGHAEGBNO, 2001). The biller may complete this task multiple times until the credit is satisfied. The biller may also bill for services that were not provided to receive higher payments from healthcare providers. These are forms of multiple, double and improper billing abuse that are defrauding the system tremendously. Healthcare claims come in quickly, and some payments are even expedited and repurposed to provide medical care… middle of paper… policies and laws put in place by the OIG are having an impact monitor fraudulent providers and claims. Claims must be reviewed to ensure that each claim is paid before it is paid, to ensure that money is not wasted. Fraud and abuse will remain a problem unless the government cracks down on providers. Works Cited Aghaegbuna, O (2011). Fraud and healthcare sanctions. FDCH Congressional Testimony. Middle Search Plus “Health Care Fraud: The Scope of the Problem.” (2012). Health Source Edition-ConsumerGatty.B (2010). Fighting Fraud US Government Cracks Down on Healthcare Scams “Dermatology Times,” 31 (11)12.Health Source-Consumer EditionHaddad, M (2010).Technology Helps Monitor Healthcare Providers. Healthcare Management Technology, 31(5), 24-25. Health Source-Consumer Edition
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