What strategies can be used to combat fraud and abuse in coding? Briefly discuss at least 6 strategies.
Please I need help with these questions of case study.
1. What strategies can be used to combat fraud and abuse in coding? Briefly discuss at least 6 strategies.
Case study:
In June 2018, HHS and OIG along
with state and federal law enforcement charged
more than 600 individuals with participating in
false billings of Medicare and Medicaid totaling
about $2 billion in Medicare and Medicaid losses.
This is the largest ever healthcare fraud law
enforcement action. Of the 600 defendants, 165
were medical professionals including physicians,
nurses, and pharmacists. Many of the defendants
were charged for their roles in prescribing
and distributing opioids and other dangerous
narcotics. Other defendants participated in submitting
false claims for treatments that were not
medically necessary and often never provided.
Some patient recruiters, beneficiaries, and others
received kickbacks in return for supplying beneficiary
information to providers for the purpose
of submitting fraudulent claims to Medicare. It
is particularly disconcerting to note that almost
every healthcare fraud scheme requires a corrupt
medical professional to be involved for the
fraud to be successful. These medical professionals
preyed on vulnerable patients who turned to
them for care and treatment (DOJ 2018b).
2. Read “Real World Case 16.1” on page 522 of your textbook and respond to the following questions.
Describe your reaction to this massive arrest of 165 medical professionals.
Identify other healthcare professionals could be charged with fraud and abuse.
Describe what is meant by a service was not medically necessary.
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