We use cookies to create the best experience for you. Keep on browsing if you are OK with that, or find out how to manage cookies.
Nobody downloaded yet

False Claims and Health Care - Essay Example

Comments (0) Cite this document
Within the last 20 years, the United States' expenditures on health care has multiplied by eight times. (Kaiser) The rate of growth has consistently surpassed inflation and growth of the national income. According to a report issued by the Centers for Medicare and Medicaid Services (CMS) health care spending is projected to reach $3.1 trillion in 2012, up from $1.4 trillion in 2001…
Download paper
False Claims and Health Care
Read TextPreview

Extract of sample
False Claims and Health Care

The primary source of fraud in health care is through false claims.
False claims are illegal and punishable through The False Claims Act, otherwise known as "Lincolns' Law". This law was enacted during the Civil War, updated by Ronald Regan in 1986 and contains "qui tam" provisions allowing ordinary citizens to sue on behalf of the government and collect restitution. (Phillip and Cohen) Also, under U.S. Code Title 18 Part I Chapter 63 section 1347 health care fraud is punishable by fine, or imprisonment for up to 10 years, or in cases of death a life sentence.
There are many types of false claims. Services not rendered is best described as billing for services that were never delivered to patients. Physicians simply add on a few extra services that they did not perform for the patient. A common example would be when ordering a complete blood count (CBC) for a patient to bill for additional blood chemistry tests that doctors hadn't performed. In this very situation, two emergency room doctors were paid $92 million after bringing to light a "whistleblower" suit against Columbia/HCA. (Phillips & Cohen)
Lack of Medical Necessity is another term used to describe a situation when a doctor or health care provider bills the insurance for procedures that are not necessary. This type of fraud is combated by practices put into place by the insurance companies such as; yearly benefit maximums, and restrictions on the number of procedures you can have. However, too often illegitimate claims are made. For example, a New York radiologist was sentenced under the False Claims Act to one to three years in prison and excluded from Medicare and state health care programs for 10 years for billing Medicaid for "thousands of medically unnecessary, duplicative, forged and unreadable sonogram tests." (Phillips & Cohen)
Kickbacks are another borderline form of health care fraud. This is the most complicated and hidden form of fraud. It involves an improper monetary or material benefit to the health care provider for prescribing or using a certain product or service. In simpler terms, someone pays a doctor per patient he will prescribe a medicine to, or perform an expensive test on. A fine example comes from a group of five hospitals in Kansas and Missouri, which paid doctors per referral to it's "geriatric center". The group of hospitals was sentenced to pay $1.2 million in restitution under the False Claims Act. There is a anti-kickback statue written into Medicare, but often the kick backs are hard to track and difficult to discover. This is an area where "whistleblowers" are most effective as it alerts the proper authorities to a scam operating.
Health care fraud will continue to be an issue as long as our current system of health insurance and care is operating. There are many flaws in the system and it is barely limping along. Many other countries, notably France, Australia, and the Netherlands have developed systems that are proven to be much more cost effective than the current American system. Fraud will continue as long is there is opportunity; the solution is to significantly lessen the opportunity and increase the punishment.


An, Jane Saloner, Romy and Ranji, Usha The Henry J. Kaiser Family Foundation "U.S. Health Care Costs" Updated January ... Read More
Cite this document
  • APA
  • MLA
(“False Claims and Health Care Essay Example | Topics and Well Written Essays - 750 words”, n.d.)
Retrieved from https://studentshare.net/miscellaneous/308762-false-claims-and-health-care
(False Claims and Health Care Essay Example | Topics and Well Written Essays - 750 Words)
“False Claims and Health Care Essay Example | Topics and Well Written Essays - 750 Words”, n.d. https://studentshare.net/miscellaneous/308762-false-claims-and-health-care.
  • Cited: 0 times
Comments (0)
Click to create a comment
Health Care System in the US
In the United States periodically to discuss, the probability of failure of existing health care system and move to nationalize "social medicine". Such health systems operate in like, UK, Germany, France, Japan, Australia and Canada. World Health Organization believes that access to health care is one of the inalienable human rights.
6 Pages(1500 words)Essay
Health Care Fraud
Healthcare is a socially relevant domain, since the practice of healthcare brings end to the sufferings of those ailing, it is considered to be a Nobel profession.  It is worth including that an oath termed as The Hippocratic Oath is taken by all doctor as they swear to practice medicine ethically and with full integrity.
8 Pages(2000 words)Essay
Health Care Ethics
In the process, it is expected that the health care professional make the right choices relating to the life and death status of the patient. Relativism dictates that every existing point of view is valid in addition to the truth being relative to the particular individual in question.
6 Pages(1500 words)Essay
Health Care Finance
Most importantly, aid is given to American citizens or the lawfully admitted immigrant. Medicaid fraud is generally committed by individuals seeking to collect healthcare reimbursements under false pretences. At instances like these Medicaid services render the help of the False Claims Act.
2 Pages(500 words)Essay
The Rising Cost of Health Care, and the Uninsured
Currently, more than 45 million Americans lack any form of health insurance, and millions more are "underinsured" - they have insurance but lack adequate financial protection from health care costs. While this problem was formerly a problem confined to low-income Americans, more and more middle-class citizens are becoming directly affected by the problem.
25 Pages(6250 words)Essay
Legal Aspects of Health Administration
This field is very respectable but there are people who are involved in doing criminal activities under the cover of health care (McGuire and Schneider, 2007). Health care fraud is a
3 Pages(750 words)Essay
HCM621-0804A-01 Ethics, Policy, and Law in Health Care Management - Phase 2 Discussion Board
one of the biggest scandals in the 20th century and how all other scandals are measured by that particular one, Watergate, part of the scandal included the burgling of a doctor’s office. Every time you hear of a new scandal it is often labeled with the additive: gate, for
2 Pages(500 words)Essay
Health care-long term and capstone discussions 2
In long-term care, culture change is a vital aspect for residents’ rights. It enables them to maintain and attain psychosocial, physical and mental well being.
4 Pages(1000 words)Essay
Myths are pseudoscience theories that are false claims
n of the supernatural beings and events in the myths has been termed as pseudoscience theories that consist more of half truths that twist a particular ideology. In the research conducted by Smith, pseudoscience entails a discussion of beliefs and assertions that are in the real
2 Pages(500 words)Essay
Health Care Fraud
According to the report there are several Statutes, agencies, organizations and partnerships that fight to uphold Medicare integrity by preventing and detecting healthcare fraud. Examples of federal laws governing health care fraud include; Anti-Kickback Statute, Social Security Act, False Claims Act, United States Criminal Code.
3 Pages(750 words)Essay
Let us find you another Essay on topic False Claims and Health Care for FREE!
Contact us:
Contact Us Now
FREE Mobile Apps:
  • About StudentShare
  • Testimonials
  • FAQ
  • Blog
  • Free Essays
  • New Essays
  • Essays
  • The Newest Essay Topics
  • Index samples by all dates
Join us:
Contact Us