False Claims and Health Care Essay Example | Topics and Well Written Essays - 750 words

False Claims and Health Care - Essay ExampleThe primary root of drool in health wish is through false claims.False claims are illegal and guilty through The False Claims Act, otherwise known as Lincolns Law. This law was enacted during the Civil War, updated by Ronald Regan in 1986 and contains qui tam provisions allowing ordinary citizens to sue on behalf of the government and collect proceeds. (Phillip and Cohen) Also, under(a) U.S. Code cognomen 18 Part I Chapter 63 section 1347 health care fraud is punishable by fine, or imprisonment for up to 10 years, or in cases of death a life sentence. there are many types of false claims. Services not rendered is best described as billing for service that were never delivered to patients. Physicians simply add on a few extra services that they did not fulfil for the patient. A common example would be when ordering a complete blood count (CBC) for a patient to bill for additional blood chemistry tests that doctors hadnt performed. In this very situation, two emergency board doctors were paid $92 million after bringing to light a whistleblower suit against capital of South Carolina/HCA. (Phillips & Cohen)Lack of Medical Necessity is another term used to describe a situation when a doctor or health care provider bills the insurance for procedures that are not necessary. This type of fraud is combated by practices put into place by the insurance companies such as yearly benefit maximums, and restrictions on the number of procedures you can have. However, too often illegitimate claims are made. For example, a New York radiologist was sentenced under the False Claims Act to one to three years in prison and excluded from Medicare and state health care programs for 10 years for billing Medicaid for thousands of medically unnecessary, duplicative, forged and unreadable sonogram tests. (Phillips & Cohen) Kickbacks are another marginal form of health care fraud. This is the most complicated and hidden form of fraud. It involves an improper monetary or material benefit to the health care provider for prescribing or using a certain fruit or service. In simpler terms, someone pays a doctor per patient he will prescribe a medicine to, or perform an expensive test on. A fine example comes from a concourse of five hospitals in Kansas and Missouri, which paid doctors per referral to its geriatric center. The group of hospitals was sentenced to pay $1.2 million in restitution under the False Claims Act. There is a anti-kickback statue written into Medicare, but often the kick backs are severe to track and difficult to discover. This is an area where whistleblowers are most effective as it alerts the proper authorities to a scam operating. Health care fraud will go to be an issue as farsighted as our current system of health insurance and care is operating. There are many flaws in the system and it is barely limping along. Many other countries, notably France, Australia, and the Netherlands have devel oped systems that are be to be much more cost effective than the current American system. Fraud will continue as long is there is opportunity the solution is to significantly lessen the opportunity and increase the punishment. BibliographyAn, Jane Saloner, Romy and Ranji, Usha The hydrogen J. Kaiser Family Foundation U.S. Health Care Costs Updated January