Today, healthcare fraud is all news. There is undoubtedly fraud in healthcare. It is the same for every business or for human touch efforts, e.g. There is no question in banking, credit, insurance, politics, etc. that healthcare providers misuse their position and our trust in thieves is a problem. People from other professions who do the same.
Why did healthcare fraud get the ‘lion’s share’? Could it be that this is the right vehicle for divergent groups to drive an agenda where taxpayers, healthcare customers and healthcare providers are guided by ‘slate-of-hands’ in the shell-game of healthcare fraud?
Take a closer look and see that this is not a game of chance. Taxpayers, consumers and suppliers will always lose because the problem of healthcare fraud is not just fraud, but our government and insurance providers use the problem of fraud for more agendas as well as failing to be accountable and a fraud. They take responsibility for what they do to simplify and develop the problem. .
- Astronomical Cost Estimates
After reporting the fraud, what are the other ways to estimate the cost of the fraud, e.g.
which increases the cost of medical care and health insurance and reduces public confidence in our health system … it There is no secret that fraud represents one. One of the fastest growing and most expensive crimes in America today… We pay these costs as taxpayers and through higher health insurance premiums .. . We must be proactive in the fight against healthcare fraud and misuse… We must ensure that law enforcement has the tools needed to prevent, detect and punish health care fraud “” [Senator Ted Kaufman ( D-DEE), 10/28/09 press release]
- The General Accounting Office (GAO) estimates that healthcare fraud is between 60 60 billion and 600 600 billion per year – or anywhere from 3% to 10% of the 2 2 trillion healthcare budget. [Healthcare Finance News Report, 10/2/09] GAO is the investigative power of Congress.
- The National Health Care Anti-Fraud Association (NHCAA) reports that fraud and illegal medical treatment involve more than $ 4 billion in theft each year in scams designed to implicate us and our insurance companies. [NHCA, web site] NHCA was created and is funded by health insurance companies.
Unfortunately, the reliability of expected assumptions is most questionable. Insurers, state and federal agencies, and others may collect fraudulent information about their own missions, where the type, quality, and quantity of information compiled varies widely. University of Maryland law professor David Hyman told us that widely publicized estimates of health care fraud and misuse (estimated at 10% of total expenditure) have no basis in experience, that we are very concerned about health care fraud and misuse Little do we know, and what we know is unproven by them. [Cato Journal, 3/22/2012]
- Health Related Standards
Laws and regulations governing healthcare – varying from state to state and from donor to collector – are pervasive and confusing for suppliers and others because they are legally written and not settled.
Providers use specific codes to report treatment status (ICD-9) and services provided (CPT-4 and HCPCS). These codes are used when seeking compensation from donors for services provided to patients. Although designed to be universally applicable to facilitate accurate reporting to reflect suppliers’ services, many insurers are instructed to report on the basis of codes that identify computer provider programs – not What the provider offers. In addition, practice building consultants instruct suppliers to report which code – in some cases codes that do not accurately reflect the service of the provider.
Consumers know what services they receive from their physicians or other providers, but those delivery codes or service descriptors may not have an idea of what they mean by the benefits they receive from insurance companies. This lack of understanding can overcome consumers without explaining what the code means or to convince some that they were billed improperly. Many insurance plans today offer wildcards for equations with varying levels of coverage when services are denied for coverage – especially if it is Medicare that is not required for treatment.
- Proactively address healthcare fraud problem
Government and insurers are actively involved