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Fraud, Waste And Abuse In Healthcare – Qs & As
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Fraud, Waste And Abuse In Healthcare – Qs & As
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Fraud, Waste And Abuse In Healthcare – Qs & AsWhat is healthcare fraud? ✔️Ans - •includes illegal acts that are performed
for financial gain
•Knowingly and willingly committing these acts
•Occur when an insurer is billed for services or medical devices that didn't
occur or weren't needed
Who can be stakeholders in committing healthcare fraud? ✔️Ans - Can be
from a variety of stakeholders
1. Crime rings improperly billing Medicare
2. Physicians charging for and performing a more complex procedure then is
necessary
3. Healthcare systems defrauding Medicare and Medicaid
4. Individual sharing their healthcare information with another person
What are some examples of Medicare fraud? ✔️Ans - •Knowingly billing
for services not furnished or supplies not provided, including billing for
appointments patients didn't keep
•Billing for nonexistent prescriptions
•Altering claim forms, medical records, or receipts to receive higher payment
What are whistleblowers? ✔️Ans - Person who exposes information or
activity that is demmed illegal, dishonest or violates professional or Clinical
standards
-no penalty for whistleblower
What is the anti-kickback statute? ✔️Ans - Prohibits knowing and willful
offer, actual payment of any type of payment to refer an individual for a
service or item that might be paid for under a federal health program.
•Only applies to federal programs. (medicare/Medicaid)
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