Medicare Fraud

Topics: Social Security, Medicare, Social Security Administration Pages: 6 (2440 words) Published: February 19, 2011
Medicare Fraud |
Ms. Iris Hobson- Introduction to Logic |
Atinuke Adumatioge|

Medicare Fraud
Healthcare today is one of the most lucrative businesses in America and many people are trying to take advantage of that. One of the reasons in the transition of street crimes is how much safer it is compared to the drug business. If we take a look at South Florida, we can see hundreds of people living the “high life”. The truth is rarely anybody sells drugs and more than half of those people are involved in healthcare, both legally and illegally. A couple of months ago, several onlookers observed a pharmacy down the street. But unlike the conventional pharmacy, there were no customers seen coming in or out. After about two weeks, the pharmacy closed up and became a warehouse. This became a concern among some of the public because true pharmacies do not fold up without warning. The authorities were notified immediately and this became a sign of Medicare fraud. Medicare is an insurance program administered by the United States government, providing health insurance coverage to people who are aged 65 and over, or who meet other special requirements. The bill was signed by President Lyndon B. Johnson as an effort to promote cheaper medical care for the elderly. Fraud is any criminal activity where one uses deceptive action for personal gain or in some cases, damage to another individual. Therefore, Medicare fraud is where people (i.e. the party involved) deceive patients and the government in order to collect reimbursement from Medicare falsely. Medicare fraud involves using others’ information, namely their social security and their Medicare number to obtain money from the government. It is considered a criminal offense, by law, and can be punished severely, usually by a substantial amount of prison time and fines. Medicare fraud is not a shock to the medical community anymore; it's becoming more commonplace to steal from the elderly, the disabled, and the handicapped, but the sad thing is that no one is doing anything significant to stop this action. We see these businesses everyday in our community, but give them barely any attention at all. Working alongside the medical community, we can conjure up a solution that is both useful and can suppress this fraudulent activity. Today, Medicare fraud is carried out in every healthcare setting imaginable. Its whereabouts are seen in hospices, hospitals, minor clinics, dental offices, optometry offices, and even in therapy offices. If one takes a look at South Florida, rehabilitation and mental health centers are also in use for Medicare fraud. If one looks hard enough, it can also be present over the Internet, usually with the indication of large flashy web banners and the promise of “free wheelchairs” or a large sum of money to partner with them. Medicare fraud usually comes in three forms: phantom billing, patient billing, and unbundling. Phantom billing is where one bills Medicare for unnecessary equipment or procedures. This is very common among parties and their associates. A common example would be a corporation billing Medicare for a colonoscopy on the behalf of a patient when the patient has never had a history of colon problems or has a different condition. Patient billing is a little more direct with respect to the patient. Sometimes, the party involved will bribe homeless individuals with food, money, and a clean place to stay if they cooperate and pretend that they are ill. During this period of time, the party would have been a step ahead, planning the next phase of the fraud. Depending on the clinical setting, certain methods of advertising will be used to lure easy bait for distraction, so that it will seem that these people are actually running legitimate clinics. For example, one hospital located in New York City had an advertising technique where they would summon the homeless with flyers and forms promising cash and food, but outside the “interview” room,...
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