Essay about Healthcare Fraud Of The United States

3820 Words Dec 3rd, 2014 16 Pages
Healthcare fraud in the Medicare system of the United States is an important factor to understand for anyone who is a citizen of the United States and will be or already is a participant in this healthcare delivery system. With increasing healthcare cost and the continual fraudulent activities that are continuing to occur in the current Medicare system, it is imperative to research and study what can be done to prevent and possibly change the current state of affairs related to provider criminal fraud. “Elimination of waste, fraud, and abuse is on the few steps about which “disparate political ideologies can agree” (Sage, 1999).” Three areas were explored in relation to fraudulent provider practices that include: upcoding, phantom billing, and the billing of medically unnecessary services in the Medicare health system. Although these are only a few of the many criminal fraudulent areas that were investigated for this paper, all areas of investigating fraudulent activities are important in the quest to combat healthcare fraud for the future of Medicare.
The Centers for Medicare and Medicaid Services (CMS) defines healthcare fraud by stating "intentional deception or misrepresentation that an individual knows to be false or does not believe to be true and makes, knowing that the deception could result in some unauthorized benefit to himself/herself or some other person." Abuse is also defined by CMS it states “when healthcare providers or suppliers perform action that…

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