Fraud is the act of soliciting funds through a deliberate bill on services which have higher compensations than the produced service or services that were never given. On the other hand, abuse is the payment for services or items that have been mistakenly billed by providers, but are not supposed to be covered by Medicare. These two, fraud and abuse are unethical practices and termed as potentially illegal. Due to the steadily growing threat on the healthcare and nursing sector, a solution had to be brought up to ensure that fraud and abuse in healthcare are scoured off. To prevent the frequent occurrences, ethical and legal means of preventing them have been suggested. As much as the ethical and legal means combating fraud and abuse are of great importance in healthcare, they are also a complication to the service of healthcare and nursing at large.
The great thing about the ethical and legal means of combating fraud and abuse in healthcare and nursing is that it helps prevent further and excessive spending thus saving more funds in the healthcare sector. The most common false claims and frauds in health care revolve around the finances (Eramo, 2017). It is estimated that every year, taxpayers incur a cost of $60 billion (Taitsman, 2011). The false claims and frauds include false claims on medical services which are not necessary, for instance, deliberately overstating the amount, complexity, type or number of services provided. False claims may also include un-rendered services on the claiming individuals or claimed by health providers (Eramo, 2017).
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Despite having the legal and ethical means to combat fraud, it still does not stand out as the best means. The main reason for battling frauds and abuse in healthcare and nursing is to curb malpractices and check on the costs applied to the medical services offered. To curb the frauds and abuses will mean that more is spent implementing the law. For instance, it is reported that the Administration of Obama allocated an increase of more than $1.7 billion for five years in support of the Health Care Fraud and Abuse Control platform (Eramo, 2017). This amount, $1.7 billion, was most definitely as a result of the taxpayers' sweat, thus more burden to the nation.
With the ethical and legal means of combating fraud and abuse in healthcare and nursing, the healthcare sector may save a lot which in return will help in the reduction of healthcare costs. So far the program has proved to be effective in curbing frauds and abuse in the healthcare sector after getting many medical practitioners behind bars (Rudman et al., 2009). Fraud and abuse are a threat not just to healthcare and nursing but also to the citizens. Fraud and abuse results to an increase in the healthcare costs; as a result consumers endure increasing premiums on insurance thus making it unaffordable to other people.
References
Eramo, A. L. “Stopping Fraud: Detecting and Preventing Fraud in the e-Health Era;” Journal of AHIMA 82, no.3 (March 2011): 28-30.
Rudman, W. J., Eberhardt, J. S., Pierce, W., & Hart-Hester, S. (2009). Healthcare Fraud and Abuse. Perspectives in Health Information Management / AHIMA, American Health Information Management Association , 6(Fall), 1g.
Taitsman, K. J. “Educating Physicians to Prevent Fraud, Waste, and Abuse;” The New England Journal of Medicine January 13, 2011; 364:102-103. doi: 10.1056/NEJMp1012609
