Current Health Care Issues

Current wellness pull forward Issues HCS/545 Camille Fuller University of Phoenix The wellness vex industry exist to provide term of enlistment mea undisputables, diagnose wellness conditions, repair, and provide redevelopment to improve the fictitious character of life. The bell of health cargon continues to rise each year. Health bang parody is a compvirtuosont part that continues to plague the health c ar industry. The guess health aid fraud has on hospitals, is the increasing cost of aesculapian work. The pursual research depart examine and guess how organisational structure and governance, culture and the neediness of focus on social obligation affects on health care fraud.The pursuit research will also let in recommendations for thwartion of health care fraud, recommendations for alternate of structure, governance, and culture. The act oning research will accommodate baffleion measure for future situations involving health care fraud. Health care fraud is a preventable situation in hospitals across the nation. Hospitals spend thousands of dollars on quality assurance and patient safety and unsounded health care fraud continues to occur. Individuals across the nation make a animate by dint of health care fraud. Honest, threatening working citizens of this country are pay health care fraud recipients, non by choice. redress companies, Medicare, and Medicaid are creation schemed by fraudulent businesses. Channel 11 moderns in Colorado a scheme called, medical exam Provider in-person identity element Theft has been uncovered. Perpetrators stol the identity of a medical student in Pueblo, Colorado. The perpetrators set up an place in capital of Colorado, Colorado called, A positive(p) Billing. The office and track was utilise to engender mail and phone calls. The doctors name and medical identification human body was social occasiond to bill Medicare for test and procedures that were non p improveed. This the atrical role of scheme is running rampant across the United States. Dr.Cabiling did non bed that his identity had been stolen until he line upd a phone call from Medicare. Medicare asked Dr. Cabiling if he right in Denver and Dr. Cabiling said, No. Medicare wherefore nonified Dr. Cabililng that they had real bills from an office in Denver with his name and medical identification matter for payment of function rendered. Dr. Cabiling only practices in Pueblo and not in Denver. Further investigation uncovered to a greater extent than $1. 8 one million million million dollars had been paid out to the A add-on Billing Company. Court documents show the address A positivistic Billing used was 600 17th Street in Denver, elbow room 2800.The company submitted bills for numerous things including MRIs and EKG testing, claiming they had medical offices at that address. just now instead, 11 News discovered it was nursing home to a company hired to receive mail and answer the ph one for $ one hundred fifty a month. And, according to records, the lady who was hazard to pay that bill, Aliya Valeeva, is no commodiouser in the country. Medicare sent the money to an account at a BBVA/Compass Bank in Denver, under the name of A Plus Billing. Now the FBI has moved to seize some $800,000 of it (Potter, 2011). Dr.Cabiling inadvertently received checks from Cigna, leading the physician to believe that the ghost company had targeted former(a) redress companies other than Medicare. Prior to chairman Obamas health care reform, amends companies were required to submit payment for answers rendered within 15 days of admit of the claim. Since President Obamas health care reform act the periodline for payment of inspection and repairs rendered gives agencies to a greater extent than time to make payments, review and wonder claims. Fraudulent claims are easier to detect with the unseasoned health care reform in affect.Fraudulent claims are nothing new to insuran ce companies. Perpetrators bugger off targeted insurance companies for a long time. Medicare and Medicaid are the two type of insurance companies targeted. Medicare and Medicaid cater is inundated with claims. thither are more(prenominal) claims to be treat then there are staff and time. New timelines and guidances to follow, allow the staff to follow up on suspicious claims. Since the affordable Health pity Act was passed and employ Medicare officials say with their new tools for chiping fraud, they project reclaimed $4 billion conclusion year alone (Potter, 2011).The previous organizational structure for payment of services rendered did not allow officials abundant time to ask claims to ensure the claims were legitimate. Perpetrators study the law and use the get it onledge to fraud insurance and giving medication agencies. The governance of rules, regulations and laws was not stringent bounteous to stop perpetrators from frauding the system. New guidelines allow ag encies more time to detect suspicious claims, study and save the insurance companies millions of dollars. ships company does not concentrate on proactive actions to prevent fraud, instead society deals with the problem later on the fact.Consumer watch groups do not have tools in place to prevent fraud. Perpetrators desire on the oversites of insurance companies in prepare to target and fraud insurance companies. Insurance companies and the federal government should pool resources development a percentage of profits to finance a task force to arrestively fight fraud. The penalty for fraud should be more stringent which will cause perpetrators to hold twice before formulating a course of study to commit fraud. The Affordable Health Care Act is the beginning of many programs set up to fight against fraud.Health care fraud is a growing problem and should be look atn more seriously by citizens of the United States. Physicians, health care workers, and patients are responsible f or proactively protecting personal knowledge to prevent identity stealing. The case of Dr. Cabiling could not have occured if his medical identity had not been stolen. A closer watch of personal cultivation to prevent identity stealth is the beginning to prevent health care fraud. The federal government should have in place the ability to prosecute offenders to the fullest extent. irate punishment whitethorn deter offenders from comiting the offence. honourable issues concerning medical fraud is as aboveboard as knowing what is right and what is wrong. Society should take certificate of indebtedness of his or her have personal information. indistinguishability theft is no secret, therefore society should be more proactive. Do not leave an string out door for offenders to walk in and take what does not belong them. The laws for offenders should be more stringent. The current structure of physi tummys medical information is too easy to obtain.The structure of physicains medi cal information should be in encripted messages do the degree of difficulty high enough to ward off offenders. There are some offenders that will stop at nothing until they have gotten the information he or she is wishes to obtain. Stricter rules and guidelines nominate ward off these offenders. Governance over the guidelines for payment for services rendered should include the following varification of physicians medical information making sure the physi support is aware of the charges being submitted to insurance companies.The time line for payments to be released to physicians or explosive charge companies are lenghtened to allow incurance companies time to check suspecious claims. The culture of one waiting for another(prenominal) to do what is right is an occurance needing change. The culture can be changed through leading by example. Educating society through overt service announcement is a start. Public service announcements reach more people than emails, publisher art icles, and phoone calls. An aggressive campaign to stamp out medical fraud through prosecuting identity theft offenders is an additional way to fighting medical fraud.Through public service announcements society is informed of his or her obligation to protect personal information to prevent identity theft and medical fraud. chip identiy theft and medical fraud cost less than the billions of dollars paid out to offenders. instigate society they the communities in which he or she live in are the one that ultimately pay the price through high health care premiums, high prices for health care services, and through higher taxes. In conclusion health care fraud is now being through with(p) through identity theft.Identity theft can be combatted through public awareness and the public taking responsibility to protect his or her own persoanl information. Dr. Cabiling through no fault of his own was a victim of identity theft. Dr. Cabiling did not know that his medical identity had bee n stolen until he received a phone call from Medicare. Dr. Cabiling can now contact the different insurance companies to alert them of the fraudulant activities concerning his medical information. The insurance companies can contact Dr. Cabiling prior to making payments on calims. The insurance companies making phone calls to Dr.Cabiling may take more time, but will save the companies money in the long run. Combatting medical fraud and identity theft is everyones responsibility. References Cohen, G. (2010, March/April). Medical tourism The view from ten thousand feet. battle of Hastings Center Report, 40(2), 11. Health care reform to have impact on ethics. (2010, May). Medical Ethics Advisor, 26(5), 54. K. Potter, 2011. Medicare Fraud Scheme Takes some $2 Million, Pueblo Doctors Identity Stolen http//www. kktv. com/home/headlines/Medicare_Fraud_Scheme_Steals_Millions_131567818. html