Learning The “Secrets” of

  • aebi
  • July 31, 2019
  • Standing up to Fraud in the Healthcare Industry

    Sometimes it would be difficult to wrap your head around the fact that fraud is practiced in places you least expect. Fraud in healthcare comes in different practices. Medical fraud involves dishonest healthcare providers fixing vital information with the hope of being reimbursed for services that they have offered the patient. Subjecting clients to tests and procedures that are not necessary as per what they are being treated for. Being aware of what you should look at when it comes to fraud is important especially with the rising cases of fraud. Fraudulent dealings are not tied to people with a certain kind of medical insurance, it could be anyone.

    The soaring cases of fraud are making the cost of medical insurance quite expensive for most people to afford. It make it necessary for people to wake up to this realization and do something about the situation. Health care fraud is not always about doing unnecessary procedures and test to the patient, in other cases, signatures of healthcare providers could be forged where they have to be for reimbursements to be successful. It is also wrong for drugs to be billed and if they have not been approved for the patient. An insurance cover will have listed the services that it covers but some uncovered services could be renamed as billable which is wrong. If a procedure is billed as a whole, dishonest health care providers could start billing it step by step to get reimbursed more.

    The most common would be services being overbilled such that the insurance gets deducted more than should be the case, in other sad cases the deductibles a and co-pays that a patient is entitled to could be deliberately waivered. Since fraud happens at more than one level in the health care system, monitoring mechanisms need to be effected at the different levels to encourage accountability and honesty. There needs to be education on anti-fraud strategies to the mass so that fraud is curbed even before it is allowed to take place. Fraud detection is being applied in different industries, it is time it was also made to work in the healthcare arena.

    Automation has saved a lot of cost time and fraud too especially where you reduce human interaction when it comes to payment. Auditing can also help with some cases of fraud especially the kind that leaves some bits of evidence in the system. Anyone seeking services in a healthcare facility needs to know that they can make a report if they fall victim to cases of fraud. However it begins by letting the masses know that they can report such cases through channels that have been set. The biggest losses amounting from fraud in health care go to the patients and their insurance companies. Vigilance from patients will help with making healthcare professionals accountable for anything fraudulent happening on their watch.