In pursuit of Fraud free Healthcare

Unfortunately, the ugly face of fraud shows up in the industries least expected, health care. Different medical practices could have cases of fraud . Medical fraud involves dishonest healthcare providers fixing vital information with the hope of being reimbursed for services that they have offered the patient. These could be cases where the doctor or another healthcare provider does unnecessary tests and procedures which the patient does not need. It will be in your favor if you know the indicators of fraud especially now that the cases are at an all-time high. Fraud is not specific to people with a certain kind of insurance hence the need to be conscious.

The high cases of fraud makes medical insurance something that most people cannot afford. It has come to a point that people have to rise against healthcare fraud because luckily there is something that people can do. Healthcare fraud goes beyond patents and healthcare provider interaction, physicians signatures could be falsified especially in cases where they are required for reimbursement to be successful. Billing for drugs that have not been approved is also fraud. Services that an insurance a cover does not cater for could be renamed so that they appear as billable. If a procedure is billed as a whole, dishonest health care providers could start billing it step by step to get reimbursed more.

The most common would be services being overbilled such that the insurance gets deducted more than should be the case, in other sad cases the deductibles a and co-pays that a patient is entitled to could be deliberately waivered. Since fraud happens at more than one level in the health care system, monitoring mechanisms need to be effected at the different levels to encourage accountability and honesty. There needs to be mass educations on how to identify and flag fraud in health institutions. Other industries that have a hard time dealing with fraud have made use of fraud detection technologies with success, the health care industry could also apply the same.

With automation you save yourself a lot of fraudulent cases, the key here is to limit human interaction especially when dealing with payment. Proper auditing also needs to be done from time to time just to check and see that everything is in order. Reporting of cases of fraud will also help in discouraging any such activities in the future. There area avenues that have been set up for this. Healthcare fraud brings losses to patients and insurance companies. Vigilance from patients will help with making healthcare professionals accountable for anything fraudulent happening on their watch.