Healthcare Billing Fraud

Healthcare Billing Fraud




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Medicare frauds in the united states has become a major problem in the entire medical companies over their clients with the fact they are unnecessarily driven towards the direction of beneficiary by only the Medicare shareholders, for instance Jay weaver, Yudel Cayro and twenty-eight others were arrested over a forty million fraud case from the Medicare analysis. Frauds involve directly through their medication process, leading to high loss of finance and in the other hand the frauds get higher profits claimed from medical agencies (Department of Justice, 2009)

According to Johnson (2009), the united states citizens have been undergoing several financial loses under the existence of the frauds. Falsifying act of the Medicare has increasing been involved without the detection from the necessary organization ion monitoring of the activities this is more evident from the deduction occurring not from the patients account but from the Medicare’s account directly bringing no doubt to the client thus the fraud is implemented internally within the beneficiaries in return of earning profits over the patient billing.

The suspects of the Medicare fraud are proven guilty and in turn they sort to pay for the prize by paying the fines inconsiderably (Allen & Greg, 2010) The insurance providers also face the problem from the ingenix company which is purported to be the leading fraud organization in line with other health care providers to which they claim not to be the involved an thus the government jets in to give an independent body to analyze the whole process as supposed by the loss experienced in correspondence to the expected expense. This is evident from the 243-people charged with them forty three doctors and other medical professionals proven guilty with Medicare fraud schemes (Allen &Greg, 2010)

According to Allen &Greg (2010), the arrest of the Hollywood doctor in Miami is an explanation of the existence of the victims in the Medicare organizations, the victims are said to be the professionals through various methods that are convincing and cherished, for instance they use the names of the gone doctors whose history were incredibly awesome to achieve the need from the clients, various ways to achieve the task are involved with the maintain is acquiring money in whatever reasons despite being paid every two weeks, as medical deductions

From the cases found in the Medicare services, it has been noticed that doctors earn financial incentives to bring up patients the facility so as to achieve the desire to earn from the clients in unlawful way, through the reports from the U.S. Department of Justice (2007), the fraud is widespread in that there are several frauds that are still under investigation for the purpose of complete close to the personnel before final judgment is made. Both the public and private sectors are involved in that they aren’t limited access to any Medicare operations; this empowers the frauds with the client acquisition

According to Moewe, (2006),false access to the medical organization under the medical organization offering the services is never limited for the believe of the medics are the ones top implement their duty, falsifying diagnostic to increase reimbursement from within the Medicare and the government at large for the purpose of convincing the client over the treatment performed so as to incur certain cost trough unnecessary services such as surgery that never was of help to the patient, more so the patient will have to payback for the services through the healthcare signed by the owners card and be charged accordingly in benefit of the involved professionals, this has reached an extend of billing the government over unnecessary services that are said to be of value but in the end is not worth the payment.

The first situation that involves use of the dead doctors as their documents to reap millions of dollars makes the billing situation a false pretense act (Ailsa Chang, 2010). The situation drives the patients to a higher percentage of being convinced that they are on the right hands towards the decision they are making, the ingenix database claimed to have been used to acquire the funds unlawfully, this also led to arrest of various professionals with the use of false pretense as an advantage to the clients, famous doctors who earned medical respect are the main ones affected more so their history is valued.

On the other way it is a billing fraud by being by the government over unnecessary lab test and wrong diagnosis provided to the patient in the process of medication which is violating the law and the rights of bills provided to the client is not worth the service, this in hand happens for the purpose of benefit to the frauds through personification in the organization. This has embarked the government to a greater percentage loss to the frauds since they are attached to trusted organizations with no doubt they have a good will to the citizens under unquestionable circumstances. (Department of Justice, 2009).

In conclusion, the existence of fraud schemes linked to the professional doctors and nurses has promoted the government towards a negative direction through low input tax as payment from the public turned to a group of people benefits this also leads to misuse of usual, customary and reasonable rates provided during the healthcare bill output, most of the client attached to such health services believe they are on the right track since the get services that are required but in a different way that is convincingly right but behind that there is a drawback of high loss and that’s a benefit scheme drawn to existence


Ailsa Chang (October 14, 2010). “52 arrested in sweeping Medicare fraud case

Allen, Greg (2010-02-23). “”. Retrieved 2012-01-02

Department of Justice (November 3, 2009). “Nation’s largest nursing home pharmacy and drug manufacturer to pay $112 million to settle false claims act cases”

Johnson, Carrie (June 25, 2009) “53 in Detroit and Miami Indicted in Medicare Fraud Sting”. The Washington Post. Retrieved May 12, 2010.

Moewe, M.C. (April 17, 2006). “Jacksonville Business Journal Friday, April 14, 2006”. Retrieved 2012-01-02.

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