Health Care Fraud
Organizational Responsibility and Current Health Care Issues Paper - Health Care Fraud
Roberta Roelofs
HCS / 545
November 17, 2014
Michael Grossman
Health care fraud is a current health care issue throughout the health care industry from hospitals to home care services. “The National Health Care Anti-Fraud Association (NHCAA) estimates that health care fraud accounts for at least three, but as much as ten percent of total health care expenditures”(Hubbell, 2006). Health care organizations that work with medicare and medicaid are at higher risk for being a target for health care fraud. Many organizations have abused the use of the money system with billing illegal charges to insurance companies to allow for themselves …show more content…
During the Medicare scheme “the defendants solicited and received kickbacks from the owners and operators of Professional Home Health in exchange for providing beneficiaries for home health services that were not medically necessary or not provided” (FBI.gov, 2014). Along with the soliciting and receiving the kickbacks, the defendants also falsified documentation to support the fraudulent billing. These charges happened between the time of December 2008 and February 2014. The owner and administrator of Professional Medical Home Health have pleaded guilty of the charges for committing health care fraud with false statements related to health care matters. During this time of December 2008 and February 2014, claims were made that services were provided for home health care services and therapy services to Medicare. Unfortunately patient information was falsified with in fact that some of the individuals never did qualify or receive such services from this …show more content…
With Professional Medical Home Health has been accused of health care fraud. Medicare being the number one target for getting billed for inaccurate charges for services being delivered. Some of the factors that have influenced health care fraud are due to the organizational structure of the company, culture, ethics, and the lack of focus on a social responsibility to the patients. The government is working with changes to help with ethical issues to help with implementing resources to help prevent health care fraud from happening in the future of the companies. Changes to the organizational structure of the company, culture, and the lack of focus on the social responsibility to the patients can also help with the prevention of health care
Roberta Roelofs
HCS / 545
November 17, 2014
Michael Grossman
Health care fraud is a current health care issue throughout the health care industry from hospitals to home care services. “The National Health Care Anti-Fraud Association (NHCAA) estimates that health care fraud accounts for at least three, but as much as ten percent of total health care expenditures”(Hubbell, 2006). Health care organizations that work with medicare and medicaid are at higher risk for being a target for health care fraud. Many organizations have abused the use of the money system with billing illegal charges to insurance companies to allow for themselves …show more content…
During the Medicare scheme “the defendants solicited and received kickbacks from the owners and operators of Professional Home Health in exchange for providing beneficiaries for home health services that were not medically necessary or not provided” (FBI.gov, 2014). Along with the soliciting and receiving the kickbacks, the defendants also falsified documentation to support the fraudulent billing. These charges happened between the time of December 2008 and February 2014. The owner and administrator of Professional Medical Home Health have pleaded guilty of the charges for committing health care fraud with false statements related to health care matters. During this time of December 2008 and February 2014, claims were made that services were provided for home health care services and therapy services to Medicare. Unfortunately patient information was falsified with in fact that some of the individuals never did qualify or receive such services from this …show more content…
With Professional Medical Home Health has been accused of health care fraud. Medicare being the number one target for getting billed for inaccurate charges for services being delivered. Some of the factors that have influenced health care fraud are due to the organizational structure of the company, culture, ethics, and the lack of focus on a social responsibility to the patients. The government is working with changes to help with ethical issues to help with implementing resources to help prevent health care fraud from happening in the future of the companies. Changes to the organizational structure of the company, culture, and the lack of focus on the social responsibility to the patients can also help with the prevention of health care