Fraud and Abuse: The Best Discussion Prompt

Fraud and abuse have always been a concern to the federal government with regard to Medicare, Medicaid, and other federally funded healthcare programs. Many remedies have been implemented through the years. The new healthcare law arms the federal government with new tools to combat fraud and waste in Medicare and in other government programs like Medicaid. What are some of the healthcare fraud schemes? What is a current OIG case of fraud or abuse? How can Medicare beneficiaries help to combat fraud?

To be able to participate fully in the discussion, please read the following article:

Jaffe, S. (2010, October 4). The new health care law and Medicare and Medicaid fraud. A..

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Answer Fraud and Abuse

………………. the strategies and opportunity to engage in unethical profit-seeking behaviour are the source of distortion in the clinical care sector, just as they are in every other industry. Patients, payers, supervisors, merchants and suppliers, and providers, including drug-trained specialists, are all included in this group (Jaffe, 2010). Clinical consideration hoodlums both inside and outside the company are also included.

Among the healthcare fraud schemes are the following:

  • Billing information for businesses is not communicated.
  • Reporting uninsured help as covered assistance.
  • Inaccurate portrayal of organization dates.
  • Inaccurately depicting organizational spaces.
  • Misrepresentation of the supplier of the organization
  • Deductibles are waived as co-payments only.
  • Incorrect goal or technique specification.
  • Excessive organizational utilization
  • Intimidation (adjustments and payoff).
  • False or inefficient prescription drug distribution

The Centers for Medicare and Medicaid Services (CMS) said in June 2018 that it intends to expand the amount of Medicaid audits carried out to prevent Medicaid from being distorted and improperly allocated. CMS The number of audits conducted on Medicaid will rise. Similar actions were taken by the public authority offices in four other states to prolong the suspension of Medicare's home prosperity selection. In high-risk conditions, the Medicare selection restriction is intended to reduce the number of ill-advised and dishonest recommendations made by home prosperity groups (Buchbinder & Shanks, 2017).

Medicare beneficiaries can assist in combat fraud by limiting access to the Medicare Card or claim number to the doctor or health care provider (Buchbinder & Shanks, 2017). They can also avoid obtaining a medical service or supply you…………..

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