Healthcare fraud is when a patient or provider turns in misleading information to a health plan required to determine the amount of benefits payable. Those who abuse the procedure put beneficiaries of welfare and health at risk and cost taxpayers millions of dollars.
Whether it’s a solo effort or an organized effort of a member, provider, or any other individual who bends the rules, healthcare fraud is a growing problem. It exploits the beneficiaries and robs them of resources crucial to their well-being.
Drawbacks of healthcare fraud
Regardless of purchasing your own insurance policy or having an employee-sponsored health insurance, the fraud translates into out-of-pocket expenses and higher premiums for victims, as well as reduction in coverage.
For government, employers and private institutions, the fraud increases the cost of providing health insurance and in return increases business cost. For many US businesses, the additional expense resulting from fraud could determine if they are able to provide effective health insurance of otherwise.
The financial losses resulting from healthcare fraud is only one aspect of the story; there are victims who get exploited and become subjected to unnecessary procedures. Or victims whose records are compromised and information is breached to submit false claims.
The case, like any fraud, requires false information to be represented like truth. A common example is of perpetrators exploiting patients by entering false diagnoses of medical conditions in their records they do not have. Such a scheme is conducted so that bogus insurance claims can be made.
Even large organizations are unable to control fraud cases and the people behind them – the amount of personal data stored in these organizations makes them an ‘attractive target’ for adversaries to submit false claims and cash in. As a result, victims often feel helpless when it comes to preventing healthcare fraud and wonder is it even possible if the large organizations can’t seem to stop frauds with all their resources in place.
Protecting your business against healthcare fraud
Organizations need to be proactive and know what resources to tap in to to prevent healthcare fraud and abuse. The following are some of the ways to reduce fraud:
Encrypt data and systems: Aside from staff, who can access the systems? Cyber criminals could assume professional practices don’t have a data breach security system. Organizations can prove them wrong by implementing SSL encryption technology. Complex passwords should be deployed for everyone having access to patient records.
Legal assistance: According to the Nelson Hardiman blog, California leads the nation in recovery of medicaid fraud funds. What was once considered as a billing error is being treated as fraud, so in the face of this trend and the increasing aggressiveness of state governments, the health insurers and federal government, there is an increasing need for sound counsel to assist organizations in avoiding allegations and responding when they arisek.
Strict background checks: Preventing healthcare fraud starts at the staff level. Organizations should not hire employees without a thorough background check that includes past records, Social Security number, education, drug tests, etc.
Strict policies: Policies and procedures can keep fraud cases on the low. Corporations should develop a strict set of procedures to keep PHI (protected health information) safe under the HIPAA (Health Insurance Portability and Accountability Act). Some healthcare fraud cases can also assist in creating this policies.
