essay introduction to public health insurance assignment
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Health Science
Date
Dec 6, 2023
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docx
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Introduction to Public Health Insurance Assignment
Introduction
The rising healthcare costs in the United States pose a significant burden on the economy.
According to the Centers for Medicare and Medicaid Services (CMS), health expenditures are
projected to increase by an average annual rate of 5.8 percent from 2015 to 2025, reaching a
staggering $5.4 trillion in 2025, up from $3 trillion in 2014. This alarming trend makes
healthcare an attractive field for fraudsters seeking illegal gains. The Federal Bureau of
Investigation (FBI) acknowledges that healthcare fraud costs amount to tens of billions of dollars
annually, with estimates indicating that these costs will continue to rise as people live longer,
leading to a higher demand for Medicare benefits. It is evident that addressing healthcare fraud is
crucial not only to control costs but also to preserve the integrity of the system.(Stowell et al.,
2018) This essay will explore the legal, ethical, and Christian aspects of reporting Medicare or
Medicaid insurance fraud and abuse, providing three examples of the actions one should take.
Legal Aspect
From a legal perspective, it is important to report any observed instances of Medicare or
Medicaid insurance fraud and abuse. The False Claims Act (FCA) provides a legal framework
for whistleblowers to expose fraudulent practices and seek legal remedies. This act encourages
individuals to come forward by offering protection against retaliation and providing a financial
reward if the case is successful (US Department of Justice, 2020). By reporting fraud, one
upholds the principles of justice and contributes to the enforcement of the law. (Stowell et al.,
2018)
Ethical Aspect
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Ethically, reporting Medicare or Medicaid insurance fraud and abuse is essential to
ensure fairness, honesty, and integrity in the healthcare system. Healthcare professionals have a
duty to act in the best interests of their patients and society as a whole. Allowing fraud and abuse
to persist undermines the trust between patients and healthcare providers, potentially
compromising patient care and the overall quality of the healthcare system. Reporting fraud is an
ethical obligation that safeguards the welfare of patients and upholds professional standards.
(Stowed et al., 2018)
Christian Aspect
From a Christian perspective, the principles of honesty, justice, and stewardship guide
our actions. The Bible teaches us to be faithful stewards of the resources entrusted to us (Luke
16:10-12), and reporting fraud and abuse within public health insurance programs aligns with
this principle. By reporting fraud, we ensure that resources are allocated appropriately, benefiting
those in genuine need. Moreover, as Christians, we are called to seek justice and righteousness
(Micah 6:8), and reporting fraud is an act of seeking justice and promoting righteousness within
the healthcare system.
Examples of Action
To illustrate the actions one should take when encountering Medicare or Medicaid
insurance fraud and abuse, consider the following examples:
1. Document and report suspicious billing practices: If a healthcare professional notices
excessive billing or billing for services not provided, they should document the evidence and
report it to the appropriate authorities, such as the Office of Inspector General (OIG). This action
ensures that fraudulent practices are brought to light and investigated.
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2. Encourage a culture of compliance: Healthcare organizations should establish robust
compliance programs that educate employees about fraud and abuse and encourage reporting. By
fostering a culture of compliance, individuals feel empowered to report suspicious activities
without fear of retaliation.
3. Support legislation and policy changes: Advocating for stronger regulations and
policies that deter fraud and abuse is another crucial action to be taken. Engaging with
lawmakers and participating in public discourse on the issue can contribute to systemic changes
that prevent fraudulent practices and protect public health insurance programs. According to the
False Claims Act, the US Department of Justice (DOJ) has the authority to provide monetary
incentives to individuals who report fraudulent activities against the federal government, as long
as they are not found guilty of any crimes related to the fraud. The reward granted can range
from 15 to 25 percent, and in certain instances, it may even reach up to 30 percent of the amount
recovered by the DOJ based on the information provided by the whistleblower. (CMS, 2021)
Conclusion
When confronted with knowledge of Medicare or Medicaid insurance fraud and abuse,
individuals have a responsibility to take action considering the legal, ethical, and Christian
aspects of the situation. Reporting fraud not only upholds the principles of justice and fairness
but also ensures the proper allocation of resources and protection of vulnerable populations. By
documenting and reporting suspicious activities, fostering a culture of compliance, and
advocating for policy changes, we can contribute to a healthcare system that operates with
integrity and serves the best interests of all.
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References
CMS. (2021). Medicare Fraud & Abuse: Prevent, Detect, Report.
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-
MLN/MLNProducts/Downloads/Fraud-Abuse-MLN4649244.pdf
Senate Homeland Security and Governmental Affairs Committee Hearing on Examining
Cms's Efforts to Fight Medicaid Fraud and Overpayments (2018). CQ Roll Call.
Supreme Court looks at whether Medicare and Medicaid were over-billed under fraud
law (2023). NPR.
Stowell, N. F., Schmidt, M., & Wadlinger, N. (2018). Healthcare fraud under the
microscope: improving its prevention. Journal of Financial Crime, 25(4), 1039–1061.
https://doi.org/10.1108/jfc-05-2017-0041
Elberg, J. (2021). Healthcare fraud means never having to say you’re sorry [Review of
Healthcare fraud means never having to say you’re sorry]. Washington Law Review, 96(2), 371–
424, 371A.