Health Care Fraud
Fraud is a serious health care issue that affects many. It can have an adverse effect on insurance premiums as well as the distribution of effective health care. Fraudulent claims can raise the price of insurance premiums because the insurance companies are paying out more for procedures not performed. This causes a negative effect on consumers in that they have to pay high premiums and may drop coverage because it is no longer affordable. Dishonest health care providers perpetrate fraud to receive more money and profit from others misfortune. There are a number of ways providers can commit fraud. Some include: upcoding, unbundling, and “falsifying a patient's diagnosis to justify tests, surgeries or other procedures that aren't medically necessary” (Cigna, 2012, para. 3). In addition, health care fraud also can be committed by dishonest consumers. These individuals file claims for services or medications that are not obtained. Another way of committing fraud is by falsifying bills or receipts. The deception created by these individuals places financial strain on insurance companies in that they have to charge higher prices to stay in business. Medicare a nonprofit organization, which receives funds from the government, this is an example of a program that is taken advantage of by fraudulent incidents. In 2011 the FBI charged 20 individuals with fraudulent behavior involving “$200 million in Medicare billing for mental health services” (The FBI Federal Bureau of Investigation, 2011, para. 1). In addition, there was also an incident involving 111 individuals who were charged with Medicare fraud, which cost Medicare $225 million, and these are just a couple of examples. Non-profit insurance companies are negatively impacted by fraud because they receive funding from the government and states. When fraud is committed the cost is passed on to the government, which generates an “additional budget deficit” (Amadeo, 2012, para. 4). This can cause...
Please join StudyMode to read the full document