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
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Health care fraud is a crime that has a significant effect on the private and public health care payment system. According to the Federal Bureau of Investigation‚ all health care programs are subject to fraud with Medicare and Medicaid being the most visible. It is estimated that fraudulent billings to both private and public health care programs are between 3 and 10 percent of total health care programs expenditures. The most recent Centers for Medicare and Medicaid (CMS) statistical estimates project
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The most interesting part in Gupta’s article is in her conclusion. The author notes that fraud in the health sector is a reality and should be exposed. Gupta further states that clinical operations are vulnerable to fraud because the system lacks effective mechanisms to detect‚ investigate‚ and prosecute individuals or groups of people who engage in fraud. Finally‚ the author calls on everyone in the health sector to develop a culture of research‚ which should be based on fundamentals of openness
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The Health Care Fraud Prevention and Enforcement Action Team (HEAT) And Its Effect on Health Care Compliance and Law Enforcement Thaedra Frangos ECM 627-Z1 Fraud Management: Risk and Compliance Professor Gary Reynolds Abstract The Health Care Fraud Prevention and Enforcement Action Team (HEAT) was created in 2009 in response to nothing short of an egregious and systemic theft problem bleeding our health care system and the American taxpayers near dry
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| | |Health Care Fraud and Abuse | | | |
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Grantham University Motivators of Fraud in Health Care: Paul L. Ewing G00019834 White-Collar Crime Mrs. Sandra J. Putnam December 25‚ 2012 What are the motivators of Health Care fraud? At first thought‚ I suspect it was for the love of money but then I felt like it has to be more to it than that. Why would people risk it all to defraud insurance companies and even the government? After a while‚ it’s clearly not about the money because the longer a company goes without being caught
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This paper attempts to analyze the fraud that is predominately a feature in the healthcare sector‚ unnecessary medical procedures‚ a term which means overutilization‚ overuse‚ or overtreatment. This crime’s expense alone accounts for about a third of healthcare spending in the united states ($750 billion out of $2.6 trillion. In the united states where the cost of taking care of one’s health is almost impossible‚ healthcare providers charges patients more to take care of needless or unwanted treatments
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downfall of an organization. Many organizations have proper processes in place to prevent health care fraud and abuse. This paper reviews fraud and abuse and how organizational structure and governance‚ culture‚ and focus on social responsibility affect or influenced the described situation. This paper will also review resources and allocation to prevent this type situation in the future‚ and the ethical issues that may relate to the determination of the described solution. Additionally‚ this paper
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Current Health Care Issues HCS/545 Camille Fuller University of Phoenix The health care industry exist to provide preventative measures‚ diagnose health conditions‚ repair‚ and provide services to improve the quality of life. The cost of health care continues to rise each year. Health care fraud is a factor that continues to plague the health care industry. The affect health care fraud has on hospitals‚ is the increasing cost of medical services. The following research will examine and evaluate
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Organizational Responsibility & Current Health Care Issues HCS - 545 11/19/2012 Organizational Responsibility & Current Health Care Issues In today’s modern world with plenty of technology‚ it is hard to believe that we cannot figure out how to reduce Medical errors. The issue of medical error is not new in health care organizations. It has been in spot light since 1990’s‚ when government did research on sudden increase in number of death in the hospitals. According to Lester‚ H
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