what is being done to reduce healthcare fraud

Near people associate white collar crime with blockbuster court cases like Enron. Just did you know there's another blazon of white collar crime that is being perpetrated thousands of times daily and costing us an estimated 272 billion dollars a year? The criminal offence is healthcare fraud and information technology is speedily growing more popular, attracting novice to seasoned criminals, and spreading like cancer across our country. The devastating effects of this criminal offense wave are existence felt by every taxpayer. We are all victims and paying the price through higher healthcare premiums and out-of-pocket expenses, reductions in our coverages, faulty medical care, and worse.

Despite efforts to hasten its growth, healthcare fraud is speedily spreading. Although policies have been put in place to reduce healthcare fraud, we, the taxpayers, may be the nigh effective deterrent. There are many things y'all can do to help forestall healthcare fraud, which we will cover later. First, let's dig into exactly what is happening and why.

Watch: What should you do if investigated for healthcare fraud?

Healthcare fraud lawyer, Robert Malove explains what practice if investigated for healthcare fraud.

Healthcare Fraud: What to Look for?

There are many types of healthcare fraud, just the most common and costly is fraud committed by quack service providers. Who are they? Doctors, nurses, equipment providers, pharmacists, etc., anyone who orders or provides healthcare services, supplies or treatments. That's right, the doctors that we depend upon and trust are often the culprits responsible for these types of crimes. Anyone tin exist a victim, that's why our tips for avoiding healthcare fraud later in this mail are so important for you to read and follow.

At that place are many ways unscrupulous service providers commit fraud. Here'due south some of the virtually common illegal practices:

Fraudulent Exercise #1: Upcoding

This is when a service is provided or a diagnosis is made, but the provider bills insurance for a more expensive service, or more serious diagnosis. So say you went in for a mammogram and your doctor then turns around and bills your insurance, or Medicare, for a more expensive type of mammogram and, or, additional tests. These tests will testify upwardly and become part of your permanent medical record. You could end up receiving care you don't need based upon these types of fictitious charges.

Fraudulent Exercise #2: Performing Unnecessary Treatments or Procedures

This occurs when a service provider performs an unnecessary treatment or procedure on you solely to take an excuse to neb insurance. Yes, as repulsive as this exercise is, it happens all the fourth dimension, from diagnostic tests to surgeries. Fully half of all primary intendance physicians believe their patients receive "too much care", or also many treatments. We are beingness over-tested and treated to our own detriment, financially, physically and emotionally. Many of the tests that are being overused are potentially harmful to the body, such every bit X-rays and CT scans. Both expose you lot to radiations, which too much of is known to cause cancer.

Here are just some of the tests procedures that nosotros are frequently over-prescribed:

EKG's and Not-Stress Tests for Heart Disease
These tests which measure the electric activity in your heart and are effective at discovering heart disease. Many people have these tests performed every year. Because the tests are not entirely accurate, this ofttimes leads to additional follow upward tests and treatments, some of which are very invasive and plush.
Imaging Tests Performed on the Lower Back
Almost of us suffer from lower back pain at some point. However, most lower back pain is temporary and volition go away on information technology's own in a short period of time. Imaging tests, similar CT scans, X-rays and MRIs are immediately frequently prescribed when a patient complains of depression dorsum pain. These all expose you lot to radiations and are generally non necessary. Almost back pain volition go away on it'due south own within a couple of weeks.
MRIs and CT Scans for Headaches
Many people become fearful when they endure from severe or repeated headaches. They ask for a scan to point whether they have brain cancer or a tumor. Doctors comply, often to avoid getting sued in case the exam is positive. This leads to many misdiagnoses and further expensive and potentially harmful tests. A CT scan to the head exposes yous to fifteen to 300 times the corporeality of radiations as a chest x-ray! Yikes! That's a big dose, especially when a thorough neurological exam and a health history assessment are mostly all that's needed.
Os Density Scans for Women who have a Low Take a chance of Osteoporosis
Women are often routinely screened for osteoporosis, or bone loss, using a Dexa scan. This examination detects osteoporosis, but also mild bone loss, commonly known a osteopenia. When osteopenia is diagnosed drugs are often prescribed to care for it, including Fosamax and Boniva. These drugs accept considerable risks and side effects, including pain in the throat, breast, bones, joints or eyes, muscle pain, abnormal heart beats, heartburn, difficulty swallowing, thigh fractures, etc. Plus, it's non fifty-fifty articulate that they are constructive for treating osteopenia.
Antibiotics for Sinusitis
Yous've probably suffered at least one sinus infection in your lifetime. That abrasive pressure in the nasal cavities, headache and often a runny nose are unhappily familiar complaints. Did yous know that most sinus infections are caused by viruses and therefore antibiotics are useless against them? However, if you prove up at your md's office complaining of those symptoms y'all most likely will walk out with a prescription for an antibody. You may think there'southward no impairment in taking an antibody when yous don't need information technology, but you're wrong. Antibiotics tin crusade a variety of side effects and overuse tin can cause leaner that are resistant to antibiotics to flourish, making you and everyone else more vulnerable to antibiotic-resistant infections.
PSA Tests for Prostate Cancer
It seems like every other man over lx is diagnosed with some sort of prostate problem, all the same, simply 3% of men dice from prostate cancer. A PSA test is a blood examination that looks for a protein in the blood that is secreted past the prostate gland. High levels of this poly peptide indicate possible prostate cancer. Positive PSA tests frequently lead to over-diagnosis and entail more tests and biopsies which can pb to incontinence and impotence. A positive PSA may not point prostate cancer. If there is cancer, repeated biopsies tin spill lethal cancer cells into the bloodstream and the lymphatic organisation, rapidly spread it. Doctors see dollars signs in men's prostates. Over xc% of physicians who recommend treatment for prostate cancer receive a committee for each treatment their patient receives.
Mammography for Breast Cancer
A cause of much argue, many experts believe that the overuse of mammography is leading to the over-diagnosis of chest cancer. Studies have shown that more than frequent screenings lead to an increase in diagnoses, but no decrease in deaths rates from the disease. In fact, many of the tumors being constitute are small and perchance not as detrimental to the body as some of the treatments, including biopsies, lumpectomies, radiation and drugs like Tamoxifen which has a host of side effects including an increased risk of uterine cancer.

These are just some of the thousands of medical tests and procedures that are existence over-prescribed often in the proper noun of profits today. Earlier you submit to a exam or procedure make sure it is absolutely necessary. When in doubt, always seek a second opinion.

Fraudulent Practice #iii: Miscoding to Embrace Uncovered Treatments

In this do a practitioner will code or mislabel a handling that is non covered by insurance with 1 that is. This happens a lot with procedures that are purely corrective, like claiming a nose job had to exist performed because of breathing bug or a deviated septum, or controversial procedures that are not yet canonical. This tin pb to doctors using unapproved treatments (with unknown side effects) on us as well equally increased insurance rates.

Fraudulent Practice #4: Purposely Misdiagnosing a Patient

Here practitioners purposely misdiagnose patients, generally claiming their illness or injuries are more serious than they actually are, so they tin pecker for more expensive treatments and procedures. Unfortunately, the elderly and mentally disabled make easy prey for these schemes, as they are less likely to question a doctor's diagnosis. An erroneous diagnosis, if recorded in your permanent health records, can cause you to receive inappropriate or inadequate care.

Fraudulent Do #v: Unbundling

This occurs when a provider bills separately for each item that occurred within one procedure, to purposely inflate the cost of the procedure. Allow's say you had a hysterectomy. Instead of billing for a hysterectomy the practitioner breaks the operation downward into all of it's different parts and bills for each part separately. Unbundling can easily double the price of a procedure!

Fraudulent Do #6: Kickbacks, Taking Money for Patient Referrals

You pat my back, I'll pat yours. Another unseemly exercise, practitioners refer patients to each other, in substitution for money or gifts. Not only does this potentially prevent you from receiving the best care, but often referrals are made for procedures, test or services y'all don't fifty-fifty need! This can exist a difficult fraud to uncover equally perpetrators cleverly disguise payments in the form of gifts, trips, etc.

Fraudulent Practice #7: Billing for Services that were Never Rendered

Using real patient data, (oft stolen), practitioners bill insurance for services, procedures, and supplies that were non provided. You may have seen the headlines, 10 amount of medical records were stolen from Y hospital. There's a reason for this. Stolen medical records are more than valuable to thieves than credit menu numbers these days. Using stolen medical records thieves ring upward thousands in phony charges.

These are just some of the virtually mutual practices beingness routinely committed past healthcare providers, but they hardly business relationship for the entirety of healthcare fraud.

Healthcare Fraud: Irresistible to Crooks and Providers akin

Alarmingly, the healthcare fraud manufacture has become then attracting that criminals from all sorts of other illegal enterprises are jumping on the bandwagon. Drug dealers reportedly like that the financial rewards are greater and the punishments less severe than their previous line of work. Mafia and gangs from many large cities are getting involved. Fraud detectives busting artificial clinics often find stockpiles of weapons.

Fueled by a growing epidemic of prescription pill addiction, pill mills take been popping up beyond the land. In this scam, a clinic or physician's function becomes a prescription writing factory and/or takes prescription pills and resells them on the streets. In Florida, the undeniable capital of healthcare fraud, it's believed that pill mills were responsible for 7 deaths a day in 2010! "Pain Direction Clinics" proliferated and over 900 existed in Florida in 2010, that number dropped to 367 in 2014 due to a statewide pill manufacturing plant fissure downwardly.

Healthcare fraud cases involving pharmacies have quadrupled in the by five years. From billing Medicare for more expensive drugs than those that are actually provided, to bribing healthcare workers for leftover pills to resell, pharmacists are getting in on the activity.

Even ambulances and ambulance workers accept found a style to scam the system. By offering patients kickbacks for pretending they can't walk, thus assuasive them to qualify for "emergency" option ups, which the ambulance visitor can accuse to Medicare for $400 a pop!

Healthcare Fraud: Why it's Happening

The simple answer is greed of form, but information technology's more complex than that. Part of the problem is the opportunity. Total healthcare spending is over $2.7 trillion a year in America or 17% of our Gross Domestic Production. With so much money flowing through the healthcare system the opportunities, and temptations, for fraud are almost limitless. The healthcare fraud industry is so enormous that crooks are constantly able to devise new ways to grab a piece of the pie.

Medicare and Medicaid: Fat Casualty that's Tedious to Change

Much of healthcare fraud is being committed confronting Medicare and Medicaid, both authorities run health insurance programs, funded with our revenue enhancement dollars. Medicare, which services the elderly, gives out over $600 billion a yr for claims. Medicaid, which is for depression-income individuals, also has an enormous upkeep, providing $415 billion a year for claims. Their sheer size makes these goliaths easy targets.

Medicare, and it'south contractors, process up to 4.5 million claims a 24-hour interval, only information technology'south estimated that only nearly one% of these claims are audited. These programs are vulnerable due to underfunding and lack of oversight. At that place just just aren't enough people on staff to check things out regularly. Plus, Medicare doesn't require claims to be verified by patients leaving the door wide open for faulty claims to be submitted and funded.

Obamacare Reforms Have Helped, But Not Enough

With the passage of Obamacare, many reforms are in the works to combat healthcare fraud. Stricter requirements and screenings for providers and suppliers, especially in those areas that have been rife with fraud, have been put into upshot. Out of nigh a million providers over 470,000 failed to run across the new standards. Moratoriums have been placed on specific areas of the country and sure types of new providers allowed into the system.

A computerized fraud prevention system that analyzes information and indicates when fishy claims are existence submitted, (for example one medico ordering dozens of prosthetic arms) has been in utilise since 2011 and identified 115 million in suspicious payments in 2012. In addition, sharing data well-nigh phony providers between private insurance and Medicare/Medicaid should help weed out more artificial providers.

Although these changes are having an bear on healthcare fraud continues to explode. Unfortunately, equally one blazon of fraud is discovered and prosecuted some other, or ten more, pop up in its place.

Like taking candy from a baby, healthcare fraud is but too lucrative and also easy to commit.

Healthcare Fraud: How to Avoid Being a Victim

In that location are many rather simple things you tin can do to avoid beingness a victim and to assistance prevent healthcare fraud on a whole.

Know your health history and ask questions

First and foremost stay on pinnacle of your health history. Be enlightened of what tests and diagnoses you take had and make sure your wellness records accurately reflect such. Keeping a healthcare journal, your own written record of your healthcare tin be very useful. Unfortunately, if errant diagnoses appear on your health record it could effect in you receiving improper care.

If your doctor orders a test or procedure yous aren't convinced you need to inquire questions. Get a second opinion if y'all're unsure of the necessity of any test or procedure. Educate yourself on what procedures and tests are commonly used or ordered for any weather condition yous may have.

Open up and review all bills and statements

Open and carefully review all bills and insurance statements for accuracy. If you find unexpected charges contact your provider get-go. Yous should wait for any charges for services you didn't get, indistinguishable charges and charges for services that were non ordered past your physician. Besides, make sure the dates of service are correct. If you spend time in the hospital be sure to check that the dates of your stay are accurate. If you lot observe errors report them to your insurance visitor. If you lot suspect fraud and you are on Medicare or Medicaid telephone call the Office of Inspector General at 800-447-8477.

If you have an elderly relative, parent or friend assist them in reviewing their bills and statements.

Know your coverages

Read over your insurance policy, including your explanation of benefits. Know which procedures are covered. Make certain that you receive the procedures for which your insurance is charged. If anything suspicious shows upward study it.

Bank check that your prescriptions are filled correctly before leaving the chemist's shop
Make certain that you are receiving the right type of medicine, dosage and the correct number of doses.

Handle identity cards carefully

Healthcare identity theft is rampant. Carefully handle your insurance, Medicare, and social security cards. Don't give them to anyone other than your dr. or Medicare provider. Protect them as you would your credit cards. If they fall into the wrong hands your entire medical history could exist compromised.

Do not entertain "free" offers

Be suspicious of and do non entertain "free offers". Keep in mind Medicare will not phone call you on the phone or visit your house to offer yous anything. Any healthcare services or tests that are being offered free of charge are potential schemes. Fraudsters may go alee and bill your insurance for the costless services yous receive if y'all accept an offer.

Providers need to have action to prevent healthcare fraud

Healthcare providers must also play a crucial role in gild to bring healthcare fraud under control. Medicare estimates that up to 60% of faulty claims are actually accidentally miscoded or mishandled. Providers need to invest in preparation and educational activity to avert committing fraud, either past accident or on purpose. Each person on staff from part personnel to doctors and nurses should know what constitutes fraud and how fraud can occur. In addition, they should learn the negative touch that healthcare fraud has on the entire healthcare system and the punishments associated with committing fraud.

Summary

We cannot afford to allow healthcare fraud to continue to spread. Additional changes demand to be made on every level to proceed this plague from farther intensifying. Non only does this rampant fraud touch every tax payer financially, just it also undermines our confidence in the healthcare arrangement equally a whole. Who wants to pay to go to the doctor if we can't trust what he says or fear that he may exist more interested in fattening his wallet than in keeping the states healthy?

Health care providers need to educate and train their staff to avoid fraudulent practices and must be actively committed to keeping the integrity of the healthcare system intact. Nosotros entrust them with our wellness, our near important asset, and they must prove themselves worthy of this trust.

Additional improvements need to be made to Medicare and Medicaid. Adequate staffing and software systems are needed to oversee and evaluate claims, and additional boots are needed on the basis to gainsay fraud at the street level. Information technology makes no sense that claims are funded without being seen by patients. A big portion of faulty merits payments could be avoided if patients approved them kickoff.

Punishments and prosecutions for healthcare fraud must exist severe and swift. Providers demand to be made aware of and fearfulness the repercussions of committing fraud. Plus, we must deter hardened criminals from getting involved and making the situation fifty-fifty worse.

The public needs to be educated about the prevalence and impact of healthcare fraud and what we can practise to forestall it. If public sensation of this problem continues to falter and no real changes are fabricated soon, we could accept a real disaster on our hands. With hardened criminals entering the healthcare fraud loonshit the crimes existence perpetrated volition get even more egregious and more widespread.

Facing Federal Healthcare Fraud Charges? Act Fast & Contact An Experienced Healthcare Fraud Attorney Today

If you're under investigation or charged with Medicare/Medicaid fraud as a medical doctor, medical dispensary, infirmary, DME carrier, dentist, or chiropractor; or the recipient of Medicare/Medicaid benefits; you need legal representation from a skilled attorney well-versed in this area of police force.

Contact The Law Offices of Robert David Malove today to schedule a confidential review of your case and to hash out all your legal options. Don't wait any longer to get the aid y'all demand. Connect with our experienced Florida Healthcare Fraud Chaser today.

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Source: https://www.robertmalovelaw.com/blog/healthcare-fraud-how-it-s-harming-you-amp-how-you-can-help-prevent-it-.cfm