Healthcare Fraud
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Healthcare fraud is one of the biggest assaults on the federal government in terms of financial deceit. It is estimated that of the $900 billion in healthcare expense almost $100 billion is obtained fraudulently (Taylor). But why is the fraud so prevalent in the healthcare industry. Because the healthcare system is so burdensome and made up of a myriad of components that it invites criminals, deceptive medical practitioners and greedy corporate people to take advantage of the system. Just recently the federal government has put a priority on tracking down and prosecuting those who commit healthcare fraud.
The National Health Care Anti-Fraud Association (NHCAA) estimates that of the nation's annual health care outlay, at least 3 percent is lost to fraud. In the year 2000 that equaled a total of $39 billion dollars
TYPES OF FRAUD
"Upcoding" is the process of billing Medicare and Medicaid for medical services is done by billing for a more serious and expensive diagnosis or procedure (Einstein 2002). For example, Medicare may pay for x-rays if there is an indication of a certain disease but not for normal routine check-ups. The provider would then submit the claim using the code for the more serious disease to get the higher reimbursement rate, even though there was no medical basis for that diagnosis.
Another common improper coding technique is called "unbundling", or fragmentation...