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Healthcare frauds are skyrocketing and the most disturbing aspect of this whole affair is the fact that healthcare providers are mostly involved in healthcare frauds. Studies show that every year around $100 million are pocketed by scammers, fraudsters and organized criminal gangs with the help of healthcare providers. Recently the law enforcement agencies busted a massive Medicare fraud estimated at $295 million. It involved over 100 doctors, nurses and other healthcare professionals. Types of Healthcare Frauds Healthcare frauds are mainly of three types and these are health insurance fraud, drug fraud and medical fraud. Health Insurance Fraud Health insurance fraud, as the name suggests, refers to frauds involving health insurance programs such as Medicare. Medicare is a social insurance program introduced by the US government to provide health insurance coverage to people who are physically disabled and those who are 65 and older. Medicare program is a soft target for fraudsters since Medicare claims are processed quickly and smoothly. Drug Fraud Drug frauds are of two types - legal drug fraud and illegal drug fraud. In illegal drug fraud, the seller combines genuine drugs with other substances to reduce its potency. This forces the consumers to buy more. Whereas, in legal drug fraud, healthcare providers prescribe drugs without sufficient cause to patients and in return earn kickbacks from the drug manufacturers. Some healthcare providers either prescribe expensive drugs and profit from the receipts or sell free drug samples to patients at very high rates. Medical Fraud Medical fraud refers to endorsement of fraudulent and unproven medical practices for making easy money. Realizing how bad corruption has seeped into the healthcare system, US government was forced to take a carrot and stick approach. As part of this approach, two laws were enacted- the Health Insurance Portability and Accountability Act (HIPAA) and the Health Information Technology for Economic and Clinical Health Act (HITECH). These two acts required all medical practitioners, healthcare providers and business associates that handle Patient Health Information (PHI) to achieve and maintain security and compliance with the regulations proposed by the HIPAA HITECH Acts. HIPAA /HITECH compliance is a complex and time-consuming process. However, the availability of innovative and unified security monitoring and HIPPA/HITECH compliance management software is making things much easier for healthcare providers, medical practitioners and business associates. It is an automated SaaS based solution that regularlyupdatesthe latest versions and revisions of relevant regulations/standards. Also read on - Hipaa healthcare, Governance risk
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HIPAA, HITECH compliance, compliance management software, Hipaa healthcare, Governance risk,
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