Healthcare Fraud and Abuse in the U.S. Healthcare System

Healthcare Fraud and Abuse in the U.S. Healthcare System

Introduction

Healthcare fraud and abuse in healthcare settings is one of the significant and prominent factors which is associated with the increasing healthcare costs in the U.S. healthcare system. Some of the most important factors that contribute in increasing the costs are the use of innovative technologies even though it has positive implication but fraud and abuse in healthcare systems is only taken as drain on the resources of healthcare. It has been estimated that healthcare fraud and abuse costs approximately $110 billion in a year, it is because of the fact that healthcare fraud and abuse has gained a lot of significance , that is why the government and people of the united states have got an attention towards curtailing such issues in healthcare settings (Werhane, 2003). This paper will be investigating the existing types of fraud and abuse in the healthcare settings, identify the people who are responsible for committing such crimes, and the reasons why such issues are taking place within healthcare settings and are more susceptible to fraud and abuse. Moreover, some of the prevention plan will also be discussed in this paper. But most importantly the structure of healthcare system in the United States will also be highlighted.

Discussion

Healthcare System in the United States

U.S. health care system is represented by independent agencies on three levels, which are family medicine, hospital care and public health. Medical services in the U.S. are private individuals and legal entities. Various commercial, charitable and government organizations offer patients both outpatient and inpatient services.  About 47% of all U.S. health care costs are the costs of hospital care, about 2% are associated with home care, and 10% associated with medication and 10% is linked with the maintenance of in nursing homes. The remaining 11% include services of dentists, ophthalmologists and other specialists. Family medicine is quite a sophisticated structure of healthcare in the United States. Family doctors examine and observe patients, and if necessary, refer them to specialists or hospital. Payment of such doctors is obtained directly from patients. Typically, the family doctor has his own office or cooperates with other professionals (U.S. Department of Health and Human Services, 2012). 

Hospital or hospitals are the largest component of health care dollars. Inpatient treatment is the most expensive and important component of the health care industry in the country. Recently, however, there are significant shifts in the direction of other agencies, mainly clinics, the emergency room, and nursing homes. Outpatient services are gradually but surely replacing hospital care and home care or stay in nursing homes. In the U.S., there are two types of hospitals: having the right of ownership, often controlled by large private corporations and non-profit hospitals that are managed by county and state authorities, religious communities or independent NGOs. The structure is similar to hospitals. They have a certain amount of out-patient care in the emergency department care and specialty clinics, but mostly they are intended to provide in-hospital care. Most attention is paid to the emergency ...