Current Health Care Issues HCS/545 Camille Fuller University of Phoenix The health care industry exist to provide preventative measures, diagnose health conditions, repair, and provide services to improve the quality of life. The cost of health care continues to rise each year. Health care fraud is a factor that continues to plague the health care industry. The affect health care fraud has on hospitals, is the increasing cost of medical services. The following research will examine and evaluate how organizational structure and governance, culture and the lack of focus on social responsibility affects on health care fraud.Current Health Care Issues Assignment
The following research will also include recommendations for prevention of health care fraud, recommendations for change of structure, governance, and culture. The following research will include prevention 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 still health care fraud continues to occur. Individuals across the nation make a living through health care fraud. Honest, hard working citizens of this country are financing health care fraud recipients, not by choice.
Insurance companies, Medicare, and Medicaid are being schemed by fraudulent businesses. Channel 11 news in Colorado a scheme called, “Medical Provider Identity Theft” has been uncovered. Perpetrators stol the identity of a physician in Pueblo, Colorado. The perpetrators set up an office in Denver, Colorado called, “A Plus Billing. ” The office and address was used to receive mail and phone calls. The physician’s name and medical identification number was used to bill Medicare for test and procedures that were not preformed. This type of scheme is running rampant across the United States. Dr.
Cabiling did not know that his identity had been stolen until he received a phone call from Medicare. Medicare asked Dr. Cabiling if he practiced in Denver and Dr. Cabiling said, “No. ” Medicare then notified Dr. Cabililng that they had received bills from an office in Denver with his name and medical identification number for payment of services rendered. Dr. Cabiling only practices in Pueblo and not in Denver. Further investigation uncovered more than $1. 8 million dollars had been paid out to the A Plus Billing Company. “Court documents show the address A Plus Billing used was 600 17th Street in Denver, room 2800.Current Health Care Issues Assignment
The company submitted bills for numerous things including MRI’s and EKG testing, claiming they had medical offices at that address. But instead, 11 News discovered it was home to a company hired to receive mail and answer the phone for $150 a month. And, according to records, the lady who was suppose to pay that bill, Aliya Valeeva, is no longer 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 nearly $800,000 of it (Potter, 2011). ” Dr.
Cabiling inadvertently received checks from Cigna, leading the physician to believe that the ghost company had targeted other insurance companies other than Medicare. Prior to President Obama’s health care reform, insurance companies were required to submit payment for services rendered within 15 days of receipt of the claim. Since President Obama’s health care reform act the timeline for payment of services rendered gives agencies more time to make payments, review and investigate claims. Fraudulent claims are easier to detect with the new health care reform in affect.