HEALTHCARE MANAGEMENT     1
HEALTHCARE MANAGEMENT     4
HEALTHCARE MANAGEMENT REGARDING ABUSE AND FRAUD
Table of Contents
Significance of Abuse and Fraud    3
Attempts made to Stop Fraud and Abuse    3
Role of Office of the Inspector General in addressing Fraud and Abuse    4
References    5
Significance of Abuse and Fraud
Fraud in the healthcare sector and abuse is a serious issue, which is affecting many patients and customers. Since the cost of healthcare is increasing significantly, the cost associated with the schemes provided to the customers for healthcare benefits is also increasing significantly. As discussed by Kratcoski (2018) that there are many cases of fraud and abuse, such as for fraud the examples are:
· Submitting claims for the services that are not provided or used
· Submitting false claims and medical records
· Misrepresenting the dates of treatment, frequency, duration of the description of any kind of medical service availed
· Billing for the services at a very higher level than necessary
· Failing to disclose the coverage that is done under other health insurance schemes
Similarly, concerning fraud, as discussed by Goel (2020) certain abuses take place in the healthcare sector, such as:
· A pattern observed for waving cost shares or any kind of deductibles
· Failure...