Hcs 545 Week 5
Organizational Responsibility and Current Health Care Issues
HCS/545
University of Phoenix
Claudette Grant
July, 01, 2013
Fraud, Abuse, and Waste in the US Healthcare System is a major problem. As a result of this the government is spending a greater percentage of the GDP on healthcare for Americans. The primary reason for this increase in the overall cost for healthcare is related to the increase in fraud, waste, and abuse. It is estimated that the United States spends between 15 and 25 billion dollars annually because of fraud, waste, and abuse. We will examine the [pic]types of fraud, waste, abuse, the[pic] involvement [pic]of the[pic] federal government in prevention, the roles of healthcare organizations and employees, and the protection for whistle-blowers and consequences for those involved in fraud, waste, and abuse. Fraud, waste and abuse can be described as the intentional deception to get an unauthorized or unwarranted benefit. A pharmacist that charges both the patient and the insurance company for a prescription is classified as fraud. A physician that prescribes unneeded tests for a patient to generate additional revenue is an example of waste. A pharmacist that receives a “brand necessary” prescription and enters the brand in the computer, charges the insurance company for the brand, but gives the patient a cheaper generic is an example of abuse Feldman (2001). Many deceptive actions classify into more than one of these categories and for this reason they have been merged into one category as fraud, waste, and abuse by the government. In recent years, the government has allocated more federal funds to combat the increase in fraud, waste and abuse. Federal and state laws have been enacted to block the spread of abuse and increase the penalizations associated with such violations. The government has also increased the number of audits performed on providers ,and as well as the number of auditors in has to perform these checks. The
HCS/545
University of Phoenix
Claudette Grant
July, 01, 2013
Fraud, Abuse, and Waste in the US Healthcare System is a major problem. As a result of this the government is spending a greater percentage of the GDP on healthcare for Americans. The primary reason for this increase in the overall cost for healthcare is related to the increase in fraud, waste, and abuse. It is estimated that the United States spends between 15 and 25 billion dollars annually because of fraud, waste, and abuse. We will examine the [pic]types of fraud, waste, abuse, the[pic] involvement [pic]of the[pic] federal government in prevention, the roles of healthcare organizations and employees, and the protection for whistle-blowers and consequences for those involved in fraud, waste, and abuse. Fraud, waste and abuse can be described as the intentional deception to get an unauthorized or unwarranted benefit. A pharmacist that charges both the patient and the insurance company for a prescription is classified as fraud. A physician that prescribes unneeded tests for a patient to generate additional revenue is an example of waste. A pharmacist that receives a “brand necessary” prescription and enters the brand in the computer, charges the insurance company for the brand, but gives the patient a cheaper generic is an example of abuse Feldman (2001). Many deceptive actions classify into more than one of these categories and for this reason they have been merged into one category as fraud, waste, and abuse by the government. In recent years, the government has allocated more federal funds to combat the increase in fraud, waste and abuse. Federal and state laws have been enacted to block the spread of abuse and increase the penalizations associated with such violations. The government has also increased the number of audits performed on providers ,and as well as the number of auditors in has to perform these checks. The
References: Amirault, B. (2009). Double-billing settlement highlights whistleblower concerns. Retrieved from http://www.healthleadersmedia.com/content/234437/topic/WS_HLM2_FIN/Double billing -Settlement-Highlights-Whistleblower-Concerns.html## Bell, D. L. (2010). Preventing fraud, waste & abuse: 2010 update computer based training. Retrieved from http://www.learnsomething.com Feldman, R. (2001). An economic explanation for fraud and abuse in public medical care programs. Journal of Legal Studies, 30, pg. 569-590. Schilling, J.W. (2008). Undercover: How I went from company man to FBI spy and exposed the worst healthcare fraud in U.S. history. New York: AMACON books