Monday, April 4, 2011

What Reform We Can Bring to Curb condition Care Fraud!

What have we created in condition care? A tower of Babel! While the market attempts to definite itself and U.S legislative and menagerial subject politicians most likely pursue their seventh effort since 1927 and President Obama made his way to the presidency by claiming that he will bring a revolution to the healthcare for the habitancy of America, but now it's more than 3 years and we haven't seen praiseworthy impact of his reforms.

A part from a political overview, healthcare is a very sensitive issue in all parts of the world. Not only the third world underdeveloped countries, the countries like United States of America and European Union has all the time been seen in emergency over healthcare across the past decades, although the advancement in science, explore and technology has brought wonders but still the condition care fraud and healthcare crimes are addition in huge numbers.

Health Care Reforms

Actually we don't in fact need a reform in the healthcare business but we need an approach to find out the places where a extremely industrialized country can also lack in services of healthcare. Picking out the condition care fraud right from its root cause can curb the qoute in a huge and deciding manner.

What Reform We Can Bring to Curb condition Care Fraud!

Health care fraud is a crime which is not roaming nearby only to the healthcare supplier level but there are other major contributors like patients, tax payers, employers, insurance plan sponsors, and healthcare vendors also.

Health care fraud steals the very essence of human life. Stories contain false claims by perpetrators, who accomplish needless procedures that disable or kill, fake insurance broker or inappropriate payer denials that leave a patient disabled or with untimely death, and fake drugs etc. The list of examples is more shocking and demoralizing and generates a sense of hopelessness.

10 Things Which Indicate a condition Care Fraud:

Medical incidents or curative practices that are not consistent with the standard of care (substandard provision of healthcare). Unnecessary cost to a healthcare program caused whether directly or indirectly. Improper cost or cost for services that fail to meet expert standards. Medically unnecessary services Substandard ability of care (e.g., in nursing homes) Elaborated Schemes and cover-up strategies and failure to meet insurance coverage requirements. False statement of services rendered or goods provided. Obtaining insurance information and filing claims for fictitious curative treatment. Unreasonable rates and misrepresentation of value and services regarding healthcare. Consumer condition care fraud. One example is forging family names to furnish coverage to friends with the intention of dividing up the reimbursement.

Recommendations for prevention of a condition Care Fraud:

Monitoring System:

Continuous monitoring of;

Patient activity. Provider activity. Payer activity. Employer activity. Vendor activity. Organized crime activity.

Prevention System:

Continuous improvement in;

Fraud prevention goals. Fraud Deterrence strategies. Fraud detection methods. Fraud investigation criteria. Fraud loss and costs saving system. Anti fraud controls, effectiveness and remediation measures. Antifraud instruction and Training.

What Reform We Can Bring to Curb condition Care Fraud!

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