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Essay / Research Paper Abstract
This 2.5 page paper is an outline for a longer paper on the identified topic. Health care fraud amounts to about $150 billion annually in the U.S. This outline includes examples of billing fraud and reports some of the funds recovered under the False Claims Act. Bibliography lists 7 sources.
Page Count:
2 pages (~225 words per page)
File: MM12_PGhthfrd.rtf
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Unformatted sample text from the term paper:
information for use in determining the amount of health care benefits payable" (Cigna, 2005). Examples of fraudulent billing by a provider include but are not limited to: * billing
for services not actually performed (Cigna, 2005). * upcoding-billing for a more costly service than the one actually performed (Cigna, 2005). Examples of fraudulent billing by a consumer include but
are not limited to: * filing claims for services or medications not received (Cigna, 2005). * forging or altering bills or receipts (Cigna, 2005). Incidence of Fraudulent Billing Health
insurance fraud and abuse is estimated at $150 billion per year in the United States (Managed Healthcare Executive, 2004). In terms of the actual annual amount spent on health care,
that means more than 10 percent of the payments are fraudulent (Managed Healthcare Executive, 2004). Fraud occurs with Medicare and Medicaid programs as well as private insurance programs (Albert, 2004).
For example, the state of California estimates fraudulent billing costs the Medi-Cal program as much as $3 billion annually, that is about 10 percent of all claims (Albert, 2004).
Regulations Related to Health Care Fraud and Impact The False Claims Act prohibits fraudulent billing practices (Hawryluk, 2004). This Act was amended in 1986, providing protection for whistle-blowers (Hawryluk, 2004,
p. 5). Since that amendment, far more cases have been successfully prosecuted (Hawryluk, 2004). In 2003, for instance, the Federal Government recovered $2.1 billion in health care fraud, primarily because
of whistle-blowers (Hawryluk, 2004). Major settlements were made against a number of health care companies in 2003 totaling $2.1 billion, $1.7 billion of which came from the False Claims Act
in 2003. Of that total, $1.7 billion came from health care companies and practitioners (Hawryluk, 2004). Of these, $1.48 billion was collected due to informers, or whistle-blowers (Hawryluk, 2004).
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