Prevention of Fraud and Abuse in Healthcare
Legal methods to prevent health care fraud and abuse are based on laws and regulations that govern the rights and responsibilities of parties to each other. These laws and regulations may be international, national, or local. For example, the U.S. Federal Health Care Fraud and Abuse Prevention Act regulates rules and procedures to prevent practices such as tampering and bribery (Timofeyev & Jakovljevic, 2022).
Additional rules and procedures may also be adopted to prevent fraud and abuse. To prevent fraud and abuse, ethical practices aim to promote integrity and proper behavior by all parties in delivering health care services. In this regard, codes of ethics and rules of conduct should be developed for all participants in health care. For example, healthcare professionals should be familiar with and follow the rules of professional ethics, risk assessment, and anti-fraud and abuse.
Influence of Fraud and Abuse in Healthcare
Fraud and abuse affect healthcare costs by increasing the cost of treatment and patient care, as well as revenue loss and profit loss. For example, adulteration of pharmaceuticals can result in the loss of a significant portion of revenue from improperly selling drugs. Bribery can result in unfair and ineffective diagnosis, treatment, and patient care, costing more than it should have. In addition, there may be victims of healthcare fraud and abuse because they may receive inadequate treatment or diagnosis.
Businesses should establish policies and procedures to prevent fraud and abuse. This should include developing and implementing control and transparency procedures to reduce risks. It may also include rules for employees regarding their financial discipline, such as the use of company money, as well as procedures for reviewing and complying with fraud prevention laws (Timofeyev & Jakovljevic, 2022).
Procedures should also be in place to review and monitor all financial transactions and movements of funds within the company. This should include measures such as regular examination of all financial transactions and the movement of funds within the enterprise, as well as developing a system of notifications of suspicious transactions (Timofeyev & Jakovljevic, 2022). In addition, this will enable the enterprise to detect potential fraud and abuse promptly and maximize the use of information against fraudsters.
Reference
Timofeyev, Y., & Jakovljevic, M. (2022). Editorial: Fraud and corruption in healthcare. Frontiers in Public Health, 10. Web.