Fraud, Abuse, and Waste Essay

1221 Words Aug 30th, 2010 5 Pages
Fraud, Abuse, and Waste in the US Healthcare System
Tony Hackman
University of Phoenix
Financial Management in Health Care
Adam Craft
August 01, 2010

Fraud, Abuse, and Waste in the US Healthcare System Healthcare insurance costs have risen at the average rate of three percent over the inflation rate for the past 10 years. As a result, the government is spending a larger percentage of GDP on healthcare for Americans. One of the reasons for this increase in the overall cost for healthcare is directly related to the increase in fraud, waste, and abuse. It is estimated that the United States spends between 15 and 25 billion dollars annually because of fraud, waste, and abuse (fwa). This paper will examine the types of
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Funding has also been provided for anti-fraud programs to educate all levels of the general population. CMS, which is the government agency that oversees Medicare, published a 70 page document on fwa requirements and recommendations in 2006. In 2009 Medicare formed the Healthcare Fraud Prevention and Enforcement Action Team (HEAT) which is a special active taskforce that focuses on fraud in Medicare programs. Collectively the Federal and State authorities that enforce fwa include the Office of the Inspector General of US Department of Health and Human Services, US Department of Justice, CMS, and the States’ attorney general. Combined, these government agencies work together to reduced fwa in the US healthcare system. Examining what these government agencies look for with be discussed next. False claims are the largest of all government healthcare fraud. These could be claims submitted for patients that were never seen, claims submitted for procedures never performed, or claims submitted for procedures that were not necessary. The intent to defraud the government is not necessary if the actions are the results of reckless disregard of gross negligence. Even if intensions are good, the US government will prosecute false claims that are submitted. Prescriptions that have been forged, altered, or purchased also fall under the category of

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