Study Document
Health Care Fraud Is a Thesis
Pages:2 (620 words)
Sources:2
Subject:Crime
Topic:Medicare Fraud
Document Type:Thesis
Document:#83165441
In the case of pill mills, participating physicians and pharmacists bill insurance companies or Medicare for prescription drugs, allowing participating beneficiaries to resell those drugs to criminal middlemen. The pharmacy then repurchases the drugs at a lower cost. According to the USGAO, any misuse of beneficiary identification information is a felony.
Criminals may also steal beneficiary information by creating drop boxes. The drop box scheme involves establishing a phony health care company in order to obtain insurance or Medicare payments. Like the drop box scheme, the pill mill scheme, and the rent-a-patient scheme, third-party billing also involves felony acts. Illegally obtaining beneficiary identification numbers, a criminal can use third-party billing agents to receive insurance payouts. The third-party billing company may not even be aware of the scheme. In other cases, the third-party billing company is a part of the scheme, defrauding by tacking on fraudulent claims to legitimate ones and then receiving insurance payments.
Other types of health care fraud include simple one-time billing for services that were never rendered. For example, a hospital might claim an ambulance was used when it was not or a doctor's office might overstate how many X-ray examinations a patient received. Any attempt to defraud an insurance provider is a potential felony, but the severity of the charges will vary depending on the extent of the crime. One instance of fraud might warrant a fine, whereas more extensive and deliberate schemes could lead to a prison sentence.
References
Cornell University Law School. "Health Care Fraud." Retrieved Aug 7, 2008 from http://topics.law.cornell.edu/wex/healthcare_fraud
United States General Accounting Office (USGAO). "Health Care Fraud." Retrieved Aug 7, 2008 from http://209.85.215.104/search?q=cache:NcKXTYWPgDEJ:www.gao.gov/new.items/os00015t.pdf+health+care+fraud&hl=en&ct=clnk&cd=5&gl=us&client=firefox-a
Sample Source(s) Used
References
Cornell University Law School. "Health Care Fraud." Retrieved Aug 7, 2008 from http://topics.law.cornell.edu/wex/healthcare_fraud
United States General Accounting Office (USGAO). "Health Care Fraud." Retrieved Aug 7, 2008 from http://209.85.215.104/search?q=cache:NcKXTYWPgDEJ:www.gao.gov/new.items/os00015t.pdf+health+care+fraud&hl=en&ct=clnk&cd=5&gl=us&client=firefox-a
Related Documents
Study Document
Fraud and Abuse Case Healthcare Fraud and
Fraud and Abuse Case Healthcare fraud and abuse continues to threaten the country, costing the facility billions of dollars per year. Brodeur, (2007) stated that fraud is something difficult to understand because it is a contagious issue. Healthcare fraud and abuse according to Brosman & Roper (2007) is the most profitable thing one can take part in if he/she is a crook, it avoid all channels and legal procedures, in nutshell,
Study Document
How to Address Healthcare Fraud in Your Agency
Miscoding on the Billing Forms Discussion Board The fundamental basis for auditing Medicare and Medicaid billing is that the services provided are confidential, patient privacy must be protected, and the written word of the provider is the record of service provision upon which a review must be initiated (Harris, 2007). Auditing, however, must extend beyond the written record to establish that the services were actually provided to the patient or client
Study Document
Healthcare - The Truth About
The experiences of seniors within the healthcare delivery system will alter how all Americans view healthcare. The healthcare delivery systems and overall organizational structure in the United States has been slow to adjust but that rest of the world is currently in flux that will migrate into our system. Technological advances in communication have made telehealth and telemedicine vialbel solutions to our outdated healthcare industry orgainzational structre. While these types
Study Document
Healthcare Integrity Is a Major Issue for
Healthcare Integrity is a major issue for healthcare organizations because there are many avenues for fraud, and for people to demonstrate a lack of ethics. The problem is that the temptation is sometimes too great and despite the fact that there are laws in place to guard against these practices unethical behavior takes place anyway. The government, which supplies a lot of the money which goes for treatments through Medicare and
Study Document
Healthcare Reform Ways the Healthcare
Transparency empowers consumers to become better shoppers. Economists assert that transparency stimulates productivity, for example, in exchange for money, one individual obtaining fair value. In every aspect, except healthcare, Davis points out, transparency, is supported. The contemporary dearth of transparency in healthcare has led to many Americans not being able to effectively shop for the best quality of service at acute care hospitals. Davis argues that transparency permits consumers,
Study Document
Health Care Cost Trends Health
As the increased costs that they are paying, will more than likely mean that they cannot afford to receive routine physicals and checkups. When you begin to reduce the number of visits, the odds increase that various conditions and ailments may be discovered once it is too late. This is when the condition has become so bad, that it will require an individual have to visit a specialist. Once