Delivering healthcare services to the public is considered a human service concept. In this respect, the administration and management of these services to the public requires constant scrutiny to ensure quality healthcare services. Currently in the United States, the introduction of Medicare as a public healthcare program requires better management.
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The United States government through the department of health and human services must ensure that hospitals do not abuse the Medicare program. However, such abuses have been reported in the recent times. This has raised concerns as to whether public health and other important human services will be addressed as required.
In an article published by Abelson and Julie Creswell (2012) in the New York Times, the authors indicate the United States government’s concerns on Medicare program delivery by hospitals. According to the article, the government is concerned that the use of electronic billing is interfering with Medicare and Medicaid programs.
From the government perspective, the use of electronic billing as a reimbursement method in the stated programs amounts to fraud. In this respect, the government has already warned doctors and hospitals against the use of such techniques.
However, the government also agrees that the use of electronic billing through electronic health records is beneficial. The government reinstates its commitment to ensuring health and human services are delivered appropriately as observed through the electronic health records standards and policies. Basically, the electronic health records (EHRs) have been instrumental in improving the delivery of healthcare services. However, false documentation through the system has been reported in some hospitals.
The fraudulent claim in delivery of healthcare services through the EHRs is done through wrong coding. Basically, the wrong coding falsifies a patient’s condition and indicates that the patient requires intensity care. In this way, the hospitals or doctors are able to get additional or false reimbursement.
The authors of the article are concerned that the increase in Medicare billing may have resulted from the falsification of electronic payment records. From the authors, the falsification of the payment records occurs from charges in the hospital emergency rooms. Records traced back in the year 2010, indicate that the Medicare reimbursement had increased by $1 billion. This is a clear indication that the introduction of the EHRs is to blame for the increasing healthcare cost.
Healthcare insurers and especially the private insurers are in agony dealing with an increasing healthcare cost. The current government is also in trouble, if it does not improve healthcare amidst the continuing fraudulent claims. In this respect, the secretary of health and human services has sent letters to major hospital associations in the country giving stern warnings.
The secretary of health and human services with the help of the attorney general warns to prosecute any hospital or doctor involved in fraudulent claims. According to the secretary, the government is bound to ensure that accuracy in health cost and recording is observed.
On the other hand, some medical practitioners and associations reiterate that the fraudulent claims are genuine and unaccepted. In order to ensure such is avoided, experts urge Medicare to provide adequate billing guidelines for hospitals. Other experts are of the opinion that hospitals and doctor can be trained on using special electronic billing software. This is only effective on the event that Medicare introduce special billing software that is not vulnerable to duplication or alterations.
Abelson, R. & Creswell, J. (2012, September 24). U.S. warning to hospitals on Medicare bill abuses. The New York Times, p. 1A.