Combating Health Care Fraud, Abuse and Waste

The health-care system is damaged in lots of ways and legislation is not going to solve the problems. In 2009 we each spent about $8, 000 on health treatment. That totaled $2. 5 trillion or almost 18 percent of the countries gross domestic product. Sadly about one quarter of that was budgeted not for health care, nevertheless for fraud! Here are some recent fraud statistics. fraud

– Medicare and Medicaid invoicing errors triggered improper obligations of $108 billion.
– Fraudulent claims for Medicare health insurance accounted for $33 million in losses.
– Incorrect private-pay payments cost about $100 billion. 
– Well being insurance fraud costs all of us about $68 billion.
– Fraudulent insurance payments cost us $50 billion.
– Payments for medical problems run about $38 billion dollars.
– About 10 percent of prescription drugs are counterfeit, costing about $12 billion 12 months.

Almost all of this means that we are wasting about $25 million per hour on medical fraud, waste material and abuse. That’s way too much and it is something that every one of us should be concerned about because, one way or another, we all pay for it. We pay for it in higher fees, higher medical costs, and higher medical insurance monthly premiums. The us government doesn’t “eat” the expense of medical fraud, waste and abuse. Neither to insurance companies or doctors. The costs, as with all frauds, are just given to to the consumers. Myself and you. We pay for the frauds.

Skilled fraud is committed almost everywhere, by just about everyone. Here is a brief set of groups that dedicate health-care fraud. Recognize any?

Who Commits Medical Fraudulence

– Criminal groups
– Employees who approve says for themselves or friends
– Providers
– Suppliers and suppliers
– Covered patients
– Uninsured patients

One of the features of the this system that makes it so vunerable to fraud is that so many players are involved in providing services to a patient and then paying for that service. Your initial players in the system will be the patient and the care company. However, it doesn’t stop there. Once the patient has seen the company the payer (patient, insurance company, government) step into the process. They are and then the employer how may pay all or part of the person’s insurance costs and/or pretax medical savings accounts, and vendors (for examples, medication stores, pharmaceutical companies, medical equipment vendors and manufactures). Medical frauds are complicated and often include at least three of the players.

Fighting Fraud, Waste and Abuse

So what can be achieved? We don’t need another study conducted by a government panel. All of us do need action. The location to start is to use consumers and citizens. A thorough scam prevention program to fight fraud starts with anti-fraud education for consumers and citizens. Everyone needs to learn how pervasive is medical fraud and what it cost each of all of us. An effective anti-fraud program commences as the grass-roots level with regular and comprehensive attention. One account in the main-stream mass media every six months will never be enough. Simply when citizens really know what the condition is and what it costs will they being combat resistant to the status quo.

The more technical aspects of an anti-fraud program to overcome health-care fraud, waste and abuse include:

– Fraudulence prevention programs – interior control systems within all health-care organizations to make it harder for site visitors to commit fraud. Sufficient review and approval techniques in conjunction with good supervision are the keystones of an internal control system.

– Fraud deterrence programs – activities that raise the likelihood that fraud will be detected if it is available. The most common example of a fraud prevention program is the carry out of frequent pro-active fraudulence audits. These are audits that are conducted to discover fraud when there is not indication that fraud exists.

– Scam detection programs – data mapping, mining and research process to find scam when it exists.

– Fraud investigation programs – reactive auditors and research conducted when there are indications that health-care scams has been committed.

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