StudentShare
Contact Us
Sign In / Sign Up for FREE
Search
Go to advanced search...
Free

False Claims and Health Care - Essay Example

Cite this document
Summary
The essay “False Claims and Health Care” looks at health care spending. With this large expenditure, it is still estimated from various agencies that anywhere 10% of all health care spending is fraudulent. The monetary price tag of health care fraud is somewhere in the vicinity of billions of dollars…
Download full paper File format: .doc, available for editing
GRAB THE BEST PAPER96.7% of users find it useful
False Claims and Health Care
Read Text Preview

Extract of sample "False Claims and Health Care"

False claims are illegal and punishable through The False Claims Act, otherwise known as "Lincolns' Law". This law was enacted during the Civil War, updated by Ronald Regan in 1986 and contains "qui tam" provisions allowing ordinary citizens to sue on behalf of the government and collect restitution. (Phillip and Cohen) Also, under U.S. Code Title 18 Part I Chapter 63 section 1347 health care fraud is punishable by fine, or imprisonment for up to 10 years, or in cases of death a life sentence.

There are many types of false claims. Services not rendered is best described as billing for services that were never delivered to patients. Physicians simply add on a few extra services that they did not perform for the patient. A common example would be when ordering a complete blood count (CBC) for a patient to bill for additional blood chemistry tests that doctors hadn't performed. In this very situation, two emergency room doctors were paid $92 million after bringing to light a "whistleblower" suit against Columbia/HCA.

(Phillips & Cohen) Lack of Medical Necessity is another term used to describe a situation when a doctor or health care provider bills the insurance for procedures that are not necessary. This type of fraud is combated by practices put into place by the insurance companies such as; yearly benefit maximums, and restrictions on the number of procedures you can have. However, too often illegitimate claims are made. For example, a New York radiologist was sentenced under the False Claims Act to one to three years in prison and excluded from Medicare and state health care programs for 10 years for billing Medicaid for "thousands of medically unnecessary, duplicative, forged and unreadable sonogram tests.

" (Phillips & Cohen) Kickbacks are another borderline form of health care fraud. This is the most complicated and hidden form of fraud. It involves an improper monetary or material benefit to the health care provider for prescribing or using a certain product or service. In simpler terms, someone pays a doctor per patient he will prescribe a medicine to, or perform an expensive test on. A fine example comes from a group of five hospitals in Kansas and Missouri, which paid doctors per referral to it's "geriatric center".

The group of hospitals was sentenced to pay $1.2 million in restitution under the False Claims Act. There is an anti-kickback statute written into Medicare, but often the kickbacks are hard to track and difficult to discover. This is an area where "whistleblowers" are most effective as it alerts the proper authorities to a scam operating. Health care fraud will continue to be an issue as long as our current system of health insurance and care is operating. There are many flaws in the system and it is barely limping along.

Many other countries, notably France, Australia, and the Netherlands have developed systems that are proven to be much more cost-effective than the current American system. Fraud will continue as long as there is an opportunity; the solution is to significantly lessen the opportunity and increase the punishment.

Read More
Cite this document
  • APA
  • MLA
  • CHICAGO
(False Claims and Health Care Essay Example | Topics and Well Written Essays - 500 words, n.d.)
False Claims and Health Care Essay Example | Topics and Well Written Essays - 500 words. Retrieved from https://studentshare.org/health-sciences-medicine/1532108-false-claims-and-health-care
(False Claims and Health Care Essay Example | Topics and Well Written Essays - 500 Words)
False Claims and Health Care Essay Example | Topics and Well Written Essays - 500 Words. https://studentshare.org/health-sciences-medicine/1532108-false-claims-and-health-care.
“False Claims and Health Care Essay Example | Topics and Well Written Essays - 500 Words”. https://studentshare.org/health-sciences-medicine/1532108-false-claims-and-health-care.
  • Cited: 1 times

CHECK THESE SAMPLES OF False Claims and Health Care

Financial Laws and Regulation in Health Industry

Everyone in the health care sector must maintain the privacy of personal information.... In the paper “Financial Laws and Regulation in health Industry” the author defines the circumstances under which entities utilize and disclose the Protected health Information (PHI).... hellip; According to the author, the privacy standards state that any individual has rights over the health information.... Question 3 According to Pratt (2000: 383) argue that Stark law, also known as ‘the physician referral law' prohibits a physician from making referrals for particular designated health services (DHS) payable by the Medicare to an entity with which he or she has a financial relationship (investment, ownership, or compensation), unless an exception....
6 Pages (1500 words) Assignment

Health Care Finance

BHS 427 - health care Finance (Module 5-CBT) ID: Word count: 537 words Medicaid ensures that proper healthcare is provided to any person who cannot afford to pay their health bill.... This plan was created to suit two purposes: to use contractors who would identify overpayments and audit claims and to provide support to combat fraud and abuse (HHS.... At instances like these Medicaid services render the help of the false claims Act.... At instances like these Medicaid services render the help of the false claims Act....
2 Pages (500 words) Essay

Preventing Fraud, Waste, and abuse Simulation

hellip; The author states that simulation in health care has diverse applications and can be categorized into eleven dimensions.... ith the increased federal and state government expenditure on health care each year, the concerns of fraud and abuse also increase.... US dollars were recovered in 2005 in false health care claims.... The aims and reasons for simulation, the element of participation, medical care domain, and know-how level of participants, types of skills, knowledge, attitudes or behaviors....
6 Pages (1500 words) Essay

Justice vs Drug Companies in the USA

These practices have created considerable confusion among health consumers who are the misleading product labels and inadequate instructions on the proper use of medications, their potential side effects and health risks  Some legal commentators have cited the extravagant internet advertising of pharmaceuticals as an important expansion of promotional strategies that often neglect to clearly state the label properties and risks associated with the use of a specific drugSection 502 of the Food and Drug Act deals specifically with issues of misbranding and false or misleading label practices by pharmaceutical companies....
5 Pages (1250 words) Research Paper

Qui Tam: Suing Physicians Who Make False Claims

Qui Tam can help to sue the physicians who make false claims and cause trouble to the patients.... The paper “Qui Tam: Suing Physicians Who Make false claims” seeks to evaluate the act or writ where an individual is capable to sue or prosecute a body under the name of the ruling government and is entitled to shares in the legal proceeds in case of any successful litigation or private settlement.... hellip; The author states that after the enactment of the 1986 amendment for the FCA or the false claims Act, there were eighteen states along with the District of Columbia who had enacted the Qui Tam legislation....
8 Pages (2000 words) Research Paper

Financial Health 2

In this movement providers are rewarded for accomplishing targets in providing health care services which serves as an important… It means that this model rewards doctors, physicians and other providers for meeting certain goals for quality and efficiency.... Due to rapidly growing population and inflation the P4P has increased health care quality in many developed countries. Total ost of care payment is similar to the comprehensive care model in which payment for the full range of health care is given by a specified group for a decided period of time....
3 Pages (750 words) Assignment

Fraudulent Practices In A Healthcare Sphere

health care fraud comprises of professional crime that entails filling of dishonest claims in healthcare facilities in order to convert them into profit.... The paper "Fraudulent Practices In A Healthcare Sphere" discusses how health care Centre has become a victim of fraudulent behaviors.... after being found guilty of over 150 counts of health care fraud, wire fraud and further making false statements in relation to health matters.... Qui Tam denotes any legal action that private individuals take in place of the government and individuals themselves in relation to an entity such as Obstetric health care center that is alleged to have acted against the government rules and regulation as they conduct their daily business with the government, over and above, other entities....
9 Pages (2250 words) Research Paper

Johnson & Johnson Settles States Cases over Risperdal

These allegations by the state of Janssen become a global history on health care fraud where Johnson & Johnson Company had to win public trust back through fine and charges.... billion to resolve cases of civil liability that arose from allegations relating to a prescription that jeopardize health care and safety of the public (Thomas, 2012)....
7 Pages (1750 words) Research Paper
sponsored ads
We use cookies to create the best experience for you. Keep on browsing if you are OK with that, or find out how to manage cookies.
Contact Us