The Common Types Of Health Care Fraud - 1231 Words

1) What is the HIPPA definition of fraud? Give an example of fraud. a. The HIPPA definition of fraud is: i. â€Å"Knowingly, and willfully executes or attempts to execute a scheme...to defraud any healthcare benefit program or to obtain by means of false or fraudulent pretenses, representations, or promises any of the money or property owned by...any healthcare benefit program†. ii. One of the most common types of health care fraud occurs when there is a misrepresentation of provided services, due to incorrect coding. 2) Define abuse as it applies to healthcare. Provide an example of abuse. a. â€Å"Abuse is most often defined in terms of acts that are inconsistent with sound medical or business practice.† i. Abuse occurs due to an unintentional practice that results in an overpayment to a provider of health care services. An example of abuse could include providing medical services that are unnecessary based on the patient’s condition, as long as the overtreatment is a non-intentional act. 3) What is the primary difference between fraud and abuse? a. The distinguishing factor between abuse and fraud is that abuse cannot be proven to have been committed intentionally, whereas fraud can. 4) What are four possible solutions in identifying and reducing fraud and abuse? a. Training and education b. Implementation of computer-assisted coding c. Increased federal enforcement of fraud and abuse monitoring d. Use of data and modeling and data mining 5) Define both traditional andShow MoreRelatedCode Violations : The Common Ways That Health Care Providers Can Defraud The Government1549 Words   |  7 Pagesof the common ways that health care providers can defraud the Government. Health care provider must enter a numerical â€Å"Procedure Code† CPT (Current Procedural Terminology) code or HCPCS (Health Care Common Procedure Coding System) code that matches the specific type of care provided to the patient in order to bill either a government health care program such as Medicare, or Medicaid or private insurance company such as Blue Cross Blue Shield or a for payment. There are many common health care providerRead MoreFinancial Issues For The Health Care System Of The United States1519 Words   |  7 PagesBackground Pozgar (2012) defines healthcare fraud as an unlawful act, which purpose is for personal gain through deception. It consists of a vast number of illegal acts and irregularities resulting from intentional deceptions. It is no surprise that healthcare fraud is difficult to combat and causes extensive financial issues for the health care system of the United States. This brings us to define what fraud is and how it relates to healthcare. Fraud generally defined as knowingly and willfullyRead MoreAnalyze a Contemporary Health Care Issue1036 Words   |  5 PagesIntroduction to Health Care Finance (HCA 240) Analyze Contemporary Health Care Issue According to the Federal Bureau of Investigation (FBI) â€Å"health care fraud costs the country an estimated $80 billion dollars a year† (Health Care Fraud, n.d., p. 1). Because health care costs continue to rise more rapidly than the rate of inflation the threat of health care fraud continues to rise. The Affordable Health Care Act has put new policies in place to identify and stop health care fraud. The FBI alongRead MoreThe Health Care Facilities And Organizations890 Words   |  4 PagesThe health care facilities and organizations are owned and operated by largely private sector businesses. These health care facilities and organizations are managed by health care managers such as administrators and executives who play important roles to make sure the facilities and organizations are free of fraud, strong business objectives and policies, and a strong financial operational and medical operation. Like any other company, the health care organizations face with health car e fraud andRead MoreEssay about Workers Compensation Fraud1575 Words   |  7 PagesWorkers Compensation Fraud Workers Compensation is a service that provides reimbursement for lost wages to employees who have sustained injuries from work or work-related tasks. It is also one of the services that is most often the victim of fraud. Each of the three types of fraud, claimant, employer, and provider, is defined by the same characteristics, outlined by the Ohio Board of Workers Compensation: #61623; Receiving workers compensation benefits that are not entitled to the claimant; Read MoreCode Violations : Common Ways That Health Care Providers Can Defraud The Government1442 Words   |  6 Pagesone of common ways that health care providers can defraud the Government. Health care provider must enter a numerical â€Å"Procedure Code† CPT (Current Procedural Terminology) code or HCPCS (Health Care Common Procedure Coding System) code that matches the specific type of care provided to the patient in order to bill either a government health care program such as Medicare, or Medicaid or private insurance company such as Blue Cross Blue Shield or a for payment. There are many common health care providerRead MoreMedicaid Fraud1530 Words   |  7 PagesMedicaid Fraud HCS/545 July 9, 2012 Medicaid fraud comes in many forms. A provider who bills Medicaid for services that he or she does not provide is committing fraud. Overstating the level of care provided to patients and altering patient records to conceal the deception is fraud. Recipients also commit fraud by failing to report or misrepresenting income, household members, residence, or private health insurance. Facilities have also been known to commit Medicaid fraud through false billingRead MoreIntroduction . There Are Several Different Types Of Crimes1620 Words   |  7 PagesIntroduction There are several different types of crimes committed against the elderly. A person is usually defined as elderly when he or she turns sixty-five or retires. The elderly population makes up a significant part of the United States population. Also, the population is expanding as the baby boomer generation began to retire. The baby boomer generation has raised some concern, because it is suspected that the baby boomer generation will be wealthier than in the past. This could leadRead MoreHipaa And The Health Care Market1543 Words   |  7 Pagesthe health care market. So what is HIPAA? HIPAA or Health Insurance Portability and Accountability Act is a federal privacy law enacted by the congress in 1996 to protect the individual personal information held by health care organizations and its business associates. The primary purpose of this law is to safeguard the confidentiality and the security of patient personal record whether be it in forms of electronics or non-electronics. Mo st importantly, HIPAA is created to deter health care entitiesRead MoreWhite Collar Crimes And Street Crimes1083 Words   |  5 Pagestheir occupations and in the furtherance of their economic and business interests (Quinney, 1964). According to Sutherland (1949), upper-class criminality was ignored by the government and the general public because the perpetrators did not fit the common stereotype of the criminal. A white-collar offender is referred to as a person who commits a financially motivated nonviolent crime through a business and/or governmental job (Braithwaite, 1985). Within criminology, the term white-collar crime was