Medicaid Fraud - 1530 Words

Medicaid 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 billing. The Medicare and Medicaid fraud and abuse statute provides that an individual who knowingly and willfully offers, pays, solicits, or receives any remuneration in exchange for referring an individual for the furnishing of any item or service†¦show more content†¦To compensate for such fraud, states must either raise taxes or decrease services in other areas. Those who most need Medicaid services may not be able to obtain benefits because resources are not available. For patients, Medicaid fraud could mean tampering with t heir medical records, which could put their health at risk. People can get hurt when doctors or other providers give less or more care than needed just to make more money. Also the public is more skeptical about social service programs as more incidents of Medicaid fraud occur every day. Providers and facilities who commit Medicaid fraud can face penalties from state and federal governments. Federal or state authorities may investigate allegations of fraud depending on where the fraud was reported, the laws broken, and the amount of money involved. The strictness of penalties levied by state governments varies from state to state. Federal laws such as The False Claims Act, Anti-Kickback Statute, and Social Security Act are laws that address fraud and abuse. Title XI of the Social Security Act contains Medicaid program-related anti-fraud provisions, which impose civil penalties, criminal penalties, and exclusions from federal health care programs on persons who engage in certain types of misconduct (Staman, 2010). Under federal regulations, providers convicted of fraud are excluded for a minimum of five years from receiving funds from any federallyShow MoreRelatedStatistics Of Medicaid Fraud That Will Shock You1285 Words   |  6 PagesStatistics of Medicaid Fraud That Will Shock You 1. In May of 2014, some 107 healthcare providers including doctors and nurses were arrested in several cities. These ones were charged with cheating the programs out of some $452 million in funds. 2. In 2010 federal officials arrested some 94 people who had filed false claims through Medicare and Medicaid, for a total of $251 million in fraudulent claims. 3. The Medicare Fraud Strike Force was formed by federal officials in 2007. The group visitedRead MoreThe Senate Committee On Health And Human Services1493 Words   |  6 Pagesdrug abuse in Texas. Also, Charge VII: to monitor the implementation of laws addressed by the committee and make recommendations for improvement of any legislation in the sectors of Medicaid long-term care, Dental Board Reforms, Cancer Prevention and Research Institute, fraud, waste and abuse reductions of Medicaid and other health and human services programs in Texas (Governor, 2014). Other duties include Charge II: monitoring the implementation of programs to improve mental health and substanceRead MoreThe Impact Of Data Mining On The Healthcare Industry1451 Words   |  6 PagesData mining is used in various forms by different agencies. Detecting fraud and abuse is one of the benefits of the use of data mining. The healthcare industry is big and one of the biggest payers is CMS. However, detecting frau d and abuse in healthcare claims is crucial because billions of money is being wasted in unnecessary care. Data mining is defined as the process of data selection and studying and building models using massive data stores to disclose previously unidentified patterns in databasesRead MoreGovernment Policies Affecting Healthcare Costs1697 Words   |  7 Pagespoor quality of care (Geyman, 2012). The purpose of this paper is to investigate the costs of healthcare. Government Policies Affecting Healthcare Costs The federal government pays for more than half of the healthcare costs through Medicare and Medicaid funding (Weeks, 2012). Therefore, a recent healthcare policy affecting healthcare costs is the Affordable Care Act also known as Obamacare. The Affordable Care Act is a law that requires health insurance reform, which alters the way Americans areRead MoreInformation Driven Technique For Extortion943 Words   |  4 Pagesanomaly discovery are recommended as compelling indicators for extortion. In view of a multi-dimensional information model produced for Medicaid claim information, particular measurements for dental suppliers were created and assessed in investigative examinations utilizing exception identification connected to claim, supplier, and patient information in a state Medicaid program. The proposed strategy empowered effective recognizable proof of fake action, with 12 of the main 17 suspicious suppliers (71%)Read MoreAn Over View of the Affordable Care Act1319 Words    |  5 Pagesprovisions that will monitor and crack down on fraud; Medicaid and Medicare will be reformed to include measures against fraud and abuse to eliminate unnecessary cost to the system. The Department of Health and Human Services predicts this reform will reduce spending by $7 billion over 10 years (Orszag, Emanuel). The expansion of bundling payments in order to pay a flat rate for an episode rather than billing separate for each service, increase Medicaid payments to primary care doctors; open enrollmentRead MoreThe Stark Law Essays1747 Words   |  7 PagesThe Stark Law Some federal statutes address fraud in government health care programs, and many of these laws vary considerably (Krause 2004). Some of these laws specifically target health care fraud. Example of the laws that the government direct at inappropriate health care activities includes the â€Å"Medicare and Medicaid Anti-Kickback Statute and Ethics in Patient Referrals Act (EPRA).† In 1989, Congress enacted the Ethics in Patient Referrals Act. Commonly known as Stark law, Congress namedRead MoreHealth Care Fraud Essay1823 Words   |  8 Pageshave been presented in previous chapters, they are worth presenting again. ï‚ § What are the major federal laws and policies related to health care fraud? ï‚ § How have these laws and policies been used to control fraud, waste, and abuse in federal health care programs? †¢ What are the impacts of these laws and policies on the war against health care fraud? To address the questions comprehensively, the researcher conducted a historical research that blended the research elements of documentary researchRead MoreThe War On Controlling Fraud And Abuse Essay2014 Words   |  9 Pages The War on Controlling Fraud and Abuse in the Current U.S. Healthcare System Introduction: Healthcare fraud and abuse has become a major issue for the United States healthcare system and affect many the citizens. The National Health Care Anti-Fraud Association (NHCAA) estimates that the financial losses due to health care fraud are in the tens of billions of dollars each year. In 2011, $2.27 trillion was spent on health care and more than four billion health insurance claims were processedRead MoreWhite House Patient Protection And Affordable Care Act Essay1487 Words   |  6 Pagesdesigned to make sure that consumers and their doctors, were in charge of their health care rather than insurance companies. The changes made in Health Care Reform laws by subsequent legislation implemented significant changes that reduced insurance fraud and protected the rights of the consumer. The Health Care Reform laws also provided world renowned benefits through health insurance marketplace’s so that business could compete to win the insurer s business. This article will attemp t to address