Health Care Fraud and Abuse - 1918 Words

| | |Health Care Fraud and Abuse | | | | | | |6/17/2012†¦show more content†¦The mission of the OIG is carried out by using a multidisciplinary, combined approach, with six major departments of the OIG in which plays a very important role. The OIG uses a nationwide network of audits, investigations, and evaluations results in timely information as well as cost-saving or policy recommendations for deciding on important matters and the community. That network also assists in the development of cases for criminal, civil and administrative enforcement. (US Department of Health and Human Services) The Immediate Office of the Inspector General is directly responsible for the overall implementation of OIG’s operation and for promoting operational administration and the attribute of OIG processes and products. The Immediate Office staff is responsible for the following: †¢ serve as liaison to the Secretary and Deputy Secretary of HHS †¢ review all existing and proposed HHS regulations and legislation †¢ promote OIG activities and accomplishments by reaching out to the public, media and other external entities †¢ compile and issue publications that provide an overview of OIG’s work, including the annual Work Plan and Semiannual Report(s) to Congress †¢ coordinate congressional testimony †¢ process all Freedom of Information Act requests †¢ Plan, conduct and participate in a variety of cooperative projects within HHS and with other Government agencies. The Office of Audit Services (OAS)Show MoreRelatedHealth Care Fraud Is A Crime1479 Words   |  6 Pages Health care fraud comes from many aspects. Fraud comes from some type of abuse to the system. Such abuse can come from billers, providers and or patients. Abuse of the system can turn into fraud. Because the fraud can come from many angles, it makes it really difficult for regulatory agencies to detect and protect against abuse and fraud. However, many changes to the system and the collaboration of regulations by many agencies have made a difference. Health care fraud is a crime that over timeRead MoreThe Current State Of Health Care System Essay1410 Words   |  6 PagesIntroduction The current state of United States’ health care system is one of the most polarizing subjects of debate among scholars and other health care professionals across the globe. This can be attributed to the fact that at one extreme end, there are some who argue that that Americans have the best system of health care in the world (MePhee, 2013). Perhaps the availability of the state-of-the-art facilities and free medical technology that have become highly symbolic of the various industriesRead MoreThe Health Insurance Portability And Accountability Act Of 1996 ( Hipaa )1686 Words   |  7 Pagesto stop fraud were enhanced under Public Law 104-191, the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The purpose was to improve the Medicare program under title XVIII of the Social Security Act, the Medicaid program under title XIX of such Act, and the efficiency and effectiveness of the health care system. This public law encouraged the development of a health inf ormation system through standards and requirements for the electronic transmission of certain health informationRead MoreMedicaid Fraud1530 Words   |  7 PagesMedicaid Fraud HCS/545 July 9, 2012 Medicaid fraud comes in many forms. A provider who bills Medicaid for services that he or she does not provide is committing fraud. Overstating the level of care provided to patients and altering patient records to conceal the deception is fraud. Recipients also commit fraud by failing to report or misrepresenting income, household members, residence, or private health insurance. Facilities have also been known to commit Medicaid fraud through false billingRead More Fraud and Abuse in the Healthcare System Essay912 Words   |  4 PagesHealthcare services have been on the rise for over 10 years now. According to a 2012 consumer alert, the industry provided $2.26 trillion in payments for more than four billion health insurance benefit claims in the year 2011(Fraud in Health Care). The bulk of the claims and the mainstream of fraud and abuse stem from the Medicare system professionals, who are knowledgeable about the process and persuade new clients into handing over their pertinent information in hopes of deception and illegitimateRead MoreMedical Fraud And The United States1004 Words   |  5 Pages Medical fraud and abuse is a huge contributing factor in the rise of healthcare costs in the United States. Although there are many definitions of fraud and abuse, according to Cigna and HIPPA, medical fraud is when there is false representation of a substance, device or a therapeutic system as a way of being beneficial in treating a medical condition, diagnosing a disease, or maintaining a state of health. Medical Abuse is defined ‘as any action that intentionally harms or injures another person’Read MoreThe Impact Of Data Mining On The Healthcare Industry1451 Words   |  6 PagesData mining is used in various forms by different agencies. Detecting fraud and abuse is one of the benefits of the use of data mining. The healthcare industry is big and one of the biggest payers is CMS. However, detecting fraud and abuse in healthcare claims is crucial because billions of money is being wasted in unnecessary care. Data mining is defined as the process of data selection and studying and building models using massive data stores to disclose previously unidentified patterns in databasesRead MoreThe Common Types Of Health Care Fraud1231 Words   |  5 Pages 1) What is the HIPPA definition of fraud? Give an example of fraud. a. The HIPPA definition of fraud is: i. â€Å"Knowingly, and willfully executes or attempts to execute a scheme...to defraud any healthcare benefit program or to obtain by means of false or fraudulent pretenses, representations, or promises any of the money or property owned by...any healthcare benefit program†. ii. One of the most common types of health care fraud occurs when there is a misrepresentation of provided services, due toRead MoreThe Billing Of Billing Medicare1587 Words   |  7 Pagescommitting the healthcare fraud. Excessive services occur when Medicare is billed for something greater than what the level of actual care requires, which can include medical related equipment as well as services sometimes. Unlike excessive services, unnecessary services occur when claims are filed for care that in no way applies to the condition of a patient, for example ordering an echo cardiogram which is later on billed for a patient who only had a sprained ankle. Healthcare fraud has been an issueRead MoreThe Computer Fraud And Abuse Act897 Words   |  4 PagesThe Computer Fraud and Abuse Act does have is befits when protecting people though. The act itself is completely necessary and has made the United states a safer place. The act protects user information from companies and hackers. In September of 2000 America Online won its case against the National Health Care Discount corporation for violation of the Computer Fraud and Abuse Act. The National Health Care Discount corporation hired emailers to send bulk emails to the internet service provider America