HEALTHCARE FRAUD Abuse AND Prevention
Health care fraud is a crime. Fraud is committed when a provider or patient intentionally submits false or misleading information to a health plan for use in determining the amount of health care benefits payable. As a Group Health member, there are steps you can take to prevent health care fraud and to report suspected fraud and abuse. There are a lot of things people can do to prevent Healthcare fraud some things that can be done Start by knowing your benefits and reading your Explanation of Benefits (EOB) statements and any paperwork received from Group Health Cooperative or your health care providers. Be wary of any "free" medical treatment, as these are usually signs. Rising costs of healthcare is a valid concern for many households in America. A factor in the cost of healthcare insurance is fraud. Fraud is often very difficult to detect. The magnitude of healthcare fraud is unknown. Initial reimbursement and payment and billing timeframe of 90 days allows for fast payment of services, however, many times before there is an indication of fraudulent billing the company has closed up and moved on. Fraud in American healthcare, costs American’s millions perhaps even billions of dollars annually. Without doubt, behind every act of fraud lies a lapse in ethics. This paper will review several pieces of literature to look regarding healthcare fraud. It will discuss the different kinds of fraud, legislation used to combat fraud, a few settled cases, and lastly discuss ways to help to combat healthcare fraud.
Fraud is the intentional deception or misrepresentation that an individual knows to be false or does not believe to be true and makes, knowing that the deception could result in an unauthorized benefit to himself/herself or another person. The most frequent kind of fraud arises from a false statement or misrepresentation made or caused to be made, that is material to entitlement or payment under the Medicare program....
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