Healthcare fraud and abuse is a common unethical practice within the healthcare environment. It accounts for a large amount of money in the annual expenditure of healthcare. Healthcare fraud occurs when healthcare professions execute false schemes to illegally benefit financially or obtain property that belongs to the healthcare facility. Healthcare abuse results to the overpayment of a healthcare professional. The two unprofessional practices have forced healthcare committees to spend millions of dollars in order to end the illegal practices. Healthcare fraud and abuse include service interpretation by the use of wrong codes, obtaining healthcare money by false pretense and tempering with claim forms in order to receive a higher pay (Rudman et al, 2009) .
Healthcare laws pertaining to fraud and abuse include the False Claim Act that prohibits healthcare facilities from providing insurance forms that have been overcharged, Physician self-referral law that prevents healthcare providers from referring patients to designated healthcare services that belong to close associates of the physicians or his close associates and are to be paid by insurance. The exclusion statue law prevents healthcare providers from taking part in fraudulent activities when delivering services or items within the healthcare environment. The charges include patient abuse and neglect, health insurance fraud and wrong billings.
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Professionalism in healthcare is good for patients and healthcare workers. It results in a variety of benefits in healthcare such as boosting the trust that patients and the community at large have in healthcare organizations, professionalism ensures that patients are safe, satisfied and have great healthcare outcomes (Postma, Oldenhof & Putters, 2015). Additionally, it improves the general performance in healthcare facilities and enhances a sense of meaning and purpose in healthcare which boosts the morale of employees, their engagement and well-being. This is a positive attribute to the general productivity in healthcare organizations. Professionalism in healthcare provides a conducive learning environment for better health care services.
References
Hart-Hester, S. (2009). Healthcare fraud and abuse. Perspectives in Health Information Management/AHIMA, American Health Information Management Association , 6 (Fall).
Postma, J., Oldenhof, L., & Putters, K. (2015). Organized professionalism in healthcare: articulation work by neighbourhood nurses. Journal of Professions and Organization , 2 (1), 61-77.
