Question

Discuss fraud and abuse in healthcare. Provide at least three specific examples of fraudulent practices that have taken place in U.S. healthcare, and describe ways to prevent these in our modern healthcare environment.

Answer 1

Answer: Fraud and abuse in healthcare has become most common. The healthcare organization must indulge some preventive methods to reduce the risk of fraud. Healthcare fraud is generally performed by the healthcare professionals itself.

The three specific examples of fraudulent practices that take place in US healthcare are:

1. Some of the fraud such as by claiming for those services that has been not provided or received.
2. Bills are manipulated.
3. Use of insurance card of another person to get the reimbursement.

Some of the ways through which it can be prevented are:

• Analysing and evaluating all the documents and information verification.
• Increase punishment and imprisonment period.
• Cross verification of the claim.