Fraud is an activity where somebody falsifies information with the intent to deceive. Abuse occurs when a medical supplier or practitioner does not adhere to the set medical practices leading to improper payments and unnecessary costs. The medical field is full of practitioners who must be upfront in abiding by ethical and legal practices. The paper discusses the legal and ethical practices that prevent abuse and fraud and their impact on healthcare and prevention procedures.
Among the most successful ways of combating fraud and abuse is the employment of federal fines. Furthermore, abuse and fraud prevention strategies have shifted from a “pay and pursue” policy to a preventative one that attempts to detect and prevent fraud in coordination with state and security agencies partners (Finkelman, 2020). The fraud prevention program is a predictive analytic system to detect high-risk claims. Furthermore, Medicare has updated the Medicare Summary Notification to aid in the detection of beneficiary fraud and inaccuracies.
Fraud and abuse practices make healthcare costly because the services are never available to deserving patients. It increases demand while limiting availability to the general public. A program called “Help Prevent Fraud” aims to educate people on how to prevent fraud victims. As part of the education process, people are reminded to never divulge their Social Security information to anyone other than authorized providers and to disclose any questionable behavior (Finkelman, 2020). There are several measures through which an organization can prevent fraud and abuse, including performing internal auditing, implementing written practice standards, carrying out public education, responding appropriately to offenses, and taking corrective action. The United States has a health policy that all players must adhere to while in practice.
Reference
Finkelman, A. (2020). Quality Improvement: A Guide for Integration in Nursing. Jones & Bartlett Learning.