Essay On Healthcare Fraud

Healthcare fraud is a major issue in our Healthcare system. It affects our overall economy and well-being of our citizens. There are many different types of healthcare frauds such as insurance fraud, drug fraud and billing fraud. Insurance fraud occurs when the insurance provider is given false insurance claims with the intent to defraud. As a result of frequent false insurance claims, the inspection procedure uses the best available experts and verification process to check the false claims. But, due to not having enough man power and heavy workload mistakes still happen and which leads to settlement of claims and waste of social resources. Drug fraud usually occurs when legal drugs or illegal drugs are used for personal profit or their prices are altered. Most of the time pharmacy workers are involved in frauds. They short count the pills or fill prescription without a refill. Pharmacy workers also have easy access to prescribed drugs which makes it easier for them to steal it. Other types of drug frauds include visiting different doctor offices to obtain narcotics, getting prescriptions on a stolen physician’s pad, impersonating medical staff to get drugs and changing the amount on doctor’s prescription.
Billing for services not provided is one of the most common frauds because it is pretty straight forward. “upcoding” , Unbundeling” and “phantom biling” are also some common terms in billing frauds. “upcoding” occurs when patients are charged for services that are higher than services actually provided. For example a patient make get charged for broken ankle even though he just has a sprain ankle. Biling for services not provides is called “phantom biling”. “unbundeling refers to services billed separately to charge more