Medicare, Medicaid Billing and Equipment Fraud - Essay Example

Medicare, Medicaid Billing and Equipment FraudMedicare fraud refers to corporation or individual that seeks the reimbursement of Medicare and Medicaid funds and equipments under false pretenses. Medicare Medicaid billing and equipment have a similar goal: to bilk Medicare program money. Though it is hard to track all frauds in Medicare because they are hardly detected and suspicious claims are considered to be fraudulent. Management and Budget Office found out that improper payments in Medicare in 2010 alone amounted to $47.

9 billion, where some of them were finally proved to be valid (Anonymous 3). However, according to anonymous (3), the Congressional Budget Office estimated total Medicare spending in 2010 to be $528 billion, giving a rough estimate of approximately 9% waste. The Medicare and medic aid are fraud targets as they are founded on the billing system of “honor”. They were initially set-up as aid to honest doctors who could help the needy access medical services. Medicare fraud is evident in phantom billing, patient billing, and up coding unbundling scheme.

Durable medical equipments are also prune to medical fraud. Examples of these equipments include oxygen supplies and wheel chairs. In equipment fraud, scammers charge Medicare for a similar wheel chair for many times without actually giving the chair to actual persons. The most recent cases of Medicare fraud focuses on infusion injections on HIV/AIDS. These injections are very expensive but patients are normally injected with common liquids or saline solutions (Anonymous 5). However Medicare is billed in such way that shows that the expensive injection was really given.

With current trends in such frauds, only law and ethical issues can stop the practice.Enforcement and Prosecution of Law in Medicare Fraud Law enforcement in Medicare fraud has defrauded Medicare very large medical scams involving attempts by rings of criminals to fraud $163 million from different healthcare organizations. 50 people out of the 73 individuals indicted in this scheme were arrested New York, Mexico, California, Georgia and Ohio on October 13, 2010 (Anonymous 6). Those convicted with Medicare fraud are convicted and penalized according to the guidelines of Federal Sentencing from HHS programs.

Therefore, law enforcement and prosecution can effectively stop this practice. Public Law 95-452 mandates the US department of Health and Human Services’ under the office of Inspector General to safeguard the integrity of this department’s programs. These include Medicaid and Medicare programs, together with the beneficiaries of welfare and health programs. Therefore, it s the right of all people needing Medicare to access genuine treatment and equipment from these programs, but this can only be achieved by strict enforcement of law.

Ethical Practices On the other hand, doctors have ethical principles that they have to strictly abide by. Therefore, if doctors who are involved in Medicare can observe these values of integrity, fraud in Medicare can be a thing of the past. Our doctors need to understand the sanctity of life. Then they can genuinely treat all patients and offer them equipments like wheel chairs genuinely, so as to safe guard life. Injecting HIV/AIDS patients with saline solutions or common liquids, while claiming to have actually offered them the most expensive medication, is very unethical, medically and socially.

The only two important things that can ensure transparency are law enforcement and observation of medical ethics. However, observation of medical ethics surpasses all other attempts. This is because, though law enforcement might be incorporated, many cases go unpunished and even if punished, many lives and funds may have already been lost. Therefore, the whole process only calls for personal integrity and ethics in the body of Medicare and Medicaid.Work CitedAnonymous. Medicare and Medicaid Fraud, November 16, 2010.

Retrieved on 21st July, 2011 from http://www.federalfraud.com/medicaid.htm.