Abuse and Fraud

Running head : Abuse and Fraud

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Abuse and Fraud

The American healthcare sector is among the biggest industries the world over , boasting of assets worth huge sums of money . It is thus prone to massive cases of fraud owing to the vast amounts of finances that insurance firms , taxpayers , the private sector , and the government commit to the sector . Such monies , meant for operational funding and research , are however sometimes fraudulently siphoned off by dishonest persons who wish to unfairly capitalize on the

system . Some of the usual healthcare fraud types include : overcharging , self referrals and kick backs as well as unbundling and upcoding . All such frauds harm various stakeholders in the healthcare sector , especially the patients who also double as taxpayers

To begin with , self referrals and kickbacks frauds occur when medical firms and doctors unscrupulously send clients back to themselves so as to obtain more compensation from insurance firms . By committing this misdemeanor , the errant parties seek to derive benefits from increased expenditure or material . The parties also seek reimbursements for referring clients to unhelpful medical practitioners . Doctors may therefore improperly plan for clients to get needless health attention so as to swindle the government as well as the insurance firms of finances (Price Norris , 2009

Referrals fraud is done in contravention of the Stark or Self-Referral Law (42 CFR 411 .353 . This law prohibits patient referrals by physicians for particular Medicare-payable health services to entities whereby the physicians or immediate family members have...