Saturday, April 9, 2011

What Reform We Can Bring to Curb condition Care Fraud!

What have we created in health care? A tower of Babel! While the market attempts to correct itself and U.S legislative and administrative field politicians most likely pursue their seventh exertion since 1927 and President Obama made his way to the presidency by claiming that he will bring a revolution to the healthcare for the population 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 health care fraud and healthcare crimes are expanding in huge numbers.

Health Care Reforms

Actually we don't admittedly need a reform in the healthcare business but we need an approach to find out the places where a very advanced country can also lack in services of healthcare. Picking out the health care fraud right from its root cause can curb the qoute in a huge and choosing 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 consist of false claims by perpetrators, who achieve needless procedures that disable or kill, fake insurance broker or inappropriate payer denials that leave a outpatient 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 health Care Fraud:

Medical incidents or medical practices that are not consistent with the appropriate of care (substandard provision of healthcare). Unnecessary cost to a healthcare schedule caused either directly or indirectly. Improper cost or cost for services that fail to meet professional 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 medical treatment. Unreasonable rates and misrepresentation of value and services concerning healthcare. Consumer health care fraud. One example is forging house names to provide coverage to friends with the intention of dividing up the reimbursement.

Recommendations for stoppage of a health 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 stoppage 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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