Health Care Fraud Term Paper

Health care fraud is a type of white-collar crime that involves the filing of dishonest health care claims in order to turn a profit. Practitioner schemes include: individuals obtaining subsidized or fully-covered prescription pills that are actually unneeded and then selling them on the black market for a profit; billing by practitioners for care that they never rendered; filing duplicate claims for the same service rendered; altering the dates, description of services, or identities of members or providers; billing for a non-covered service as a covered service; modifying medical records; intentional incorrect reporting of diagnoses or procedures to maximize payment; use of unlicensed staff; accepting or giving kickbacks for member referrals; waiving member co-pays; and prescribing additional or unnecessary treatment.

Members can commit health care fraud by providing false information when applying for programs or services, forging or selling prescription drugs, using transportation benefits for non-medical related purposes, and loaning or using another’s insurance card.

2011 saw a total loss of £341 million (Money Super Market, 2011)....

[tags: Fraud, Credit card, Credit card fraud] - Fraud Identification and Classification Identifying fraud and understanding the difference between fraud and errors or omissions is an important aspect of business management.

Insurance fraud is one of the most common types of frauds seen nowadays.

Most people have heard of this type of fraud and may even have stories of it....

[tags: Insurance, Life insurance, Insurance fraud, Fraud] - Introduction This report will attempt to clarify the culture at Health South with Richard Scrushy as the CEO; how his management style contributed to the company’s ethical and financial damages and his own downfall.

There will also be an analytical comparison of other companies and CEO’s who had similar company cultures.

These costly reforms sought to improve financial disclosures from organizations, establish audit standards, inspect accounting firms, and enforce compliance with all rules highlighted by the Sarbanes-Oxley Act.

However, fraud occurrence has not been impacted....


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