Healthcare Fraud Essay Example

invest in General Service (AS) or Wage Grade (WIG) workers who can oversee Medicare payment operations. Additionally, implementing random calling methods can help ensure that prescriptions are received by the correct individuals. If any signs of wrongdoing are discovered during these calls, the worker would express gratitude to the individual and forward the results to an investigator.

Private insurance providers have an advantage in detecting fraud due to their smaller size and ability to establish rapport with insured clients. While they may not be completely immune to fraudulent activity, they are often better positioned to investigate certain illicit practices employed by criminals. According to Loretta AT ten Notational Health n care Anta-Fraud Association (NCAA), health care identity theft was prevalent in the industry last year. One common method used for theft involves authorized personnel within the healthcare community selling patient information to illicit groups or organizations. These sellers, including hospital administrators or individuals with access to personal information, often initiate most cases of fraud.The information is used by criminals to create fake bills for equipment, prescription drugs, and treatments from Medicare and private insurance companies. Additionally, smaller-scale fraud involves selling medical insurance to those who cannot afford it. The fraudulent sellers receive money that is deposited into an account which they close once they become aware of an investigation. Thieves also exploit Medicare by ordering unnecessary wheelchairs and overcharging up to two or three times the actual cost, keeping the extra money for themselves. This false billing procedure allows thieves to profit from both health insurance and the pharmaceutical industry.

Within this context, drug fraud becomes a topic of discussion as well. Prescription drug fraud includes illegally

obtaining controlled substances without a valid prescription for personal use or profit. Interestingly, about 2/3rd of the most commonly abused drugs can be obtained with a prescription as mentioned in the article. Regardless of race, sex, or religion, individuals participating in prescription drug fraud are primarily driven by drug addiction.

Fraudulent activities involving prescription drugs include stealing a doctor's prescription pad, forging and altering prescriptions, as well as impersonating hospital staff to obtain prescriptions. The punishments for this type of fraud can vary depending on the circumstances and identity of the offender.It is important to recognize warning signs related to prescription drug fraud, including copies of prescriptions, excessive pill quantities prescribed, and duplicate prescriptions. Those involved in this type of fraud may face serious consequences such as imprisonment and significant fines. Medical professionals found guilty could lose their license, while those engaging in healthcare-related insurance fraud might endure 20 to 30 years in federal prison. In the United States, prescription drug fraud is treated similarly to other drug crimes and can result in up to five years of imprisonment. Engaging in prescription drug fraud not only has legal ramifications but also impacts an individual's personal and professional life long-term (Vassal, 2010). The severity of punishment for first-time offenders may vary based on the judge's leniency, the offender's ability to repay lost funds, and the duration of the offense. Certain individuals may also receive higher fines. Thieves engaged in prescription drug fraud frequently target elderly individuals and those dependent on government assistance. This type of fraud often originates in Miami but spreads to other cities like California, Detroit, and Houston (Civilian, 2010). Fraudsters use tactics such as

mail fraud or exploiting the mail of elderly friends or relatives to deceive victims.The use of technology has made it easier for criminals to commit fraud by gaining unauthorized access to patient records and identities. They can hack digital records and steal money from the $450 billion Medicare system, which serves 44 million beneficiaries. This targeting by fraudsters not only causes financial loss for taxpayers but also puts patients at risk as their information can be tampered with or mixed up with someone else's, potentially causing harm.

To combat fraud and save billions of dollars, President Obama encouraged a shift from paper to electronic medical records. He set a five-year deadline for all Americans to have digital medical records and provided incentives to hospitals for using technology efficiently in accessing information. In 2009, the Obama administration established the Medicare Fraud Task Force to address healthcare fraud and target criminals who steal billions of dollars from Medicare spending. This initiative aims to gather resources from various government departments through the Health Care Fraud Prevention and Enforcement Team (Services) in order to fight against waste, fraud, and abuse in the Medicare and Medicaid programs.

It is crucial for everyone, not just the medical community, to remain vigilant against healthcare fraud as it involves taxpayers' money. Social programs are especially vulnerable due to their widespread accessibility.The government's response to the concern of individuals stealing money has been the creation of the President's fraud task force, responsible for overseeing this issue. It is necessary for us to shift our cultural approach towards trust and carefully scrutinize insurance programs while also safeguarding personal medical information. From an ethical perspective, there should be

stricter punishments imposed on those involved in defrauding the government, with a particular focus on targeting the elderly who are most impacted by these schemes. Ultimately, it is crucial to address the financial impact of healthcare fraud as significant amounts of money have already been lost due to individuals exploiting the system for their own gain. As taxpayers, we must take action to prevent corruption and fraudulent activities that could jeopardize not only our healthcare but also the well-being of our children.