Motivators of Fraud in Health Care Essay

What are the motivators of wellness finagle fraud? At first thought, I suspect it was for the roll in the hay of money allay then I felt like it has to be more to it than that. Why would people risk it all to defraud amends companies and even the government? After a while, its clearly non about the money because the longer a friendship goes without being caught, they wint be hurting for financial wealth so wherefore continue? How do you know when you are being charged for try on and check that you dont need? During this essay, I will effect these questions as well as describe what acts as motivators for these health Care frauds. According to the text, the health guard industry is the (single largest single industry) in the join States economy.The structure of todays health system, it leaves huge opportunities for fraud to inquire place. Back in the early 1980s remediates would provide medical care to forbearings and then later file a claim with the issuance company o f the patient or send a bill in the transmit for the patient. Prior to a doctor submitting his or her bill, it would be reviewed by a medical coder who was able to determine the legitimacy of treatment that was required. With the comportment of modern technology, doctors file their claims but now they are reviewed by computers which diffuse the door for more opportunities to defraud the amends companies. In these situation, I musical note the fraud in this case is motivated by the fact that those insurance companies dont find it very important to review claims and thereof are only getting always with what insurers are allow to.Those committing healthcare fraud include organized criminal groups, individuals, and health care providers. The individuals committinghealthcare fraud see the crime as low risk and superior reward since many perpetrators are never caught. If they are caught the penalties are relatively less severe than other crimes. For example, in a 2010 study on the effectiveness of healthcare fraud taskforces, the average convicted offender original third to five years, but the total amount of fraudulent billings in the two hundred sampled cases exceeded a billion dollars. The most common form of fraud is inconclusive billing. There are a wide variety of billing schemes, but generally a person committing fraud will bill an insurer for a service that was never performed. For example, many perpetrators will obtain patient information from hospitals or other sources and use that information to charge two public and personal health programs for false reimbursement claims.How can you tell when you are at risk of being charged for treatment not received or not needed? Picture this scenario, a lady goes into a minimum care facility and tells the receptionist that she has a pain in her hand, the receptionist tells her that she call for an roentgen rays. The patient responds by wanting to see the doctor first. The receptionist tells that pa tient that it is communications protocol that they get X-rays before the doctor will see her. The lady gets the X-ray and is then seen by the doctor who finds a cyst and the patient is tempered and released. In that scenario, this medical facility disguised unneeded charges by protocol. No one actually knows the extent or motivators of fraud in healthcare, we know only estimates and the bases for them often seem a tad bit flimsy. I feel that Healthcare frauds happen for two reasons, greed for financial transcendence and there is no jail time in most cases. initial of all, Healthcare is rarely paid for out of pocket and the consumers of the healthcare operate have little incentive to check their bills. Unless the actual payer of the bills fulfill with the receiver of the service or treatment, the crimes of overcharging, will go unnoticed. The insurance companies, private and public third-party payment programs, were not in the room when the services were provided and do not know whether they were needed or actually supplied. Finally, when a doctor makes 10 jillion dollars because of overcharging, charging for services not required or not given and he is only fined 5 or 6 million dollar and theres no jail time. He still came out on top and continues to practice medicine because he rationalizes it by blaming it on the patients, bookkeepers and even the government.ReferencesBenson, M. L. & Simpson, S. S. (2010). White-Collar Crime An Opportunity Perspective, research, 9-12. https//www.nampi.org/members/2010presentations/KeynoteAddress.pdf http//mjpetro.typepad.com/7th_circuit_alert/2011/07/42-usc-1320a-7b-medicare-fraud-primary-motivation-doctrine-rejected.html