Standing up to Fraud in the Healthcare Industry
Unfortunately, the ugly face of fraud shows up in the industries least expected, health care. Different medical practices could have cases of fraud . Fraud could take the form where a dishonest care provider falsifies sensitive information in the medical records of the patient with the hope they will be reimbursed for the services provided. Fraud could be in the form of carrying out unnecessary procedures on the patient or tests. Being aware of what you should look at when it comes to fraud is important especially with the rising cases of fraud. It doesn’t matter the kind of healthcare insurance you have, you can become a victim of fraud.
The high cases of fraud makes medical insurance something that most people cannot afford. These facts are rubbing people the wrong and at some point it becomes necessary to do what you can to correct 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. Billing for drugs that have not been approved is also fraud. An insurance cover will have listed the services that it covers but some uncovered services could be renamed as billable which is wrong. In other absurd cases, medical procedures could be billed step by step instead of one which in real sense is wrong and shouldn’t be the case.
Medical service being overbilled is certainly not new, but in this case dishonest health care providers will even waiver deductibles that people are entitled to. To fight fraud in the healthcare system, there needs to be evaluated at different levels. Education and any form of training that can be provided on fighting fraud to the masses will come in handy as that will create alertness in people seeking medical services. Fraud detection technologies will also help with this problem especially backed by the fact that it has worked in other areas.
Automation has saved a lot of cost time and fraud too especially where you reduce human interaction when it comes to payment. Proper auditing also needs to be done from time to time just to check and see that everything is in order. Anyone seeking services in a healthcare facility needs to know that they can make a report if they fall victim to cases of fraud. There area avenues that have been set up for this. 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.