University of Phoenix
The health care industry exist to provide preventative measures, diagnose health conditions, repair, and provide services to improve the quality of life. The cost of health care continues to rise each year. Health care fraud is a factor that continues to plague the health care industry. The affect health care fraud has on hospitals, is the increasing cost of medical services. The following research will examine and evaluate how organizational structure and governance, culture and the lack of focus on social responsibility affects on health care fraud. The following research will also include recommendations for prevention of health care fraud, recommendations for change of structure, governance, and culture. The following research will include prevention measure for future situations involving health care fraud. Health care fraud is a preventable situation in hospitals across the nation. Hospitals spend thousands of dollars on quality assurance and patient safety and still health care fraud continues to occur. Individuals across the nation make a living through health care fraud. Honest, hard working citizens of this country are financing health care fraud recipients, not by choice. Insurance companies, Medicare, and Medicaid are being schemed by fraudulent businesses. Channel 11 news in Colorado a scheme called, “Medical Provider Identity Theft” has been uncovered. Perpetrators stol the identity of a physician in Pueblo, Colorado. The perpetrators set up an office in Denver, Colorado called, “A Plus Billing.” The office and address was used to receive mail and phone calls. The physician’s name and medical identification number was used to bill Medicare for test and procedures that were not preformed. This type of scheme is running rampant across the United States. Dr. Cabiling did not know that his identity had been stolen until he received a phone call from Medicare....