Hcm 200 - Fiscal Bodies

Adam Mensah

Fiscal Bodies

HCM 200-41WW (FA15)

10/16/2015

        The first issue related to fiscal bodies who control or regulate payments and fiscal matters for healthcare organization is healthcare fraud and abuse. Individuals can be afflicted by healthcare fraud and abuse directly and indirectly. To begin with, fraud is described as a deliberate deception, dishonest assertion or falsehood made by an individual with the conscious that the deception could possibly result in non-permitted benefits to that individual. Abuse is described as procedures that are irregular with professional regulations of care or medical needs. Fraud and abuse can executed by physicians, patients, and private insurers. Places of activity for fraud and abuse that takes place in the healthcare system includes billing for assistance that has not been provided, overbilling for assistance provided, misdiagnosing health conditions in order to bypass financial accountability for the suitable treatment of bad health. High costs of premiums and copayments is a result of fraud and abuse. With the lessening of fraud and abuse, premiums and copayments would not be so high. Taxpayers provide money for federal programs including Medicaid and Medicare, which are federal programs that adopt the fraud and abuse cases. Fraud and abuse is responsible for a great chunk of annual payments for the healthcare organization. These enormous costs are preventable and restrict the power to provide worldwide healthcare that are efficient and affordable for every individual. Physicians carry out fraud and abuse insurers just to push up the cost of assistances. Additionally, individuals being treated for medical problems carry out fraud and abuse insurers and federal programs to acquire preventable services, fees, and a medical process. Private insurers are involved in fraud and abuse by subsidizing federal programs just to degrade medical claims and stay far away from budgeting accountability for important medical services. Raised expenses of fraud and abuse results in higher insurance premiums, taxes, and expenses for medical treatment. Fraud and abuse in the healthcare system displays a first concern of money over health, positions patients at risk and slows down individual’s national curiosity of quality care. Medicaid and Medicare are particularly defenseless to fraud because worthy individuals might never acknowledge their money owed for services going straight to a fiscal intermediary for Medicare and a nominated payer for Medicaid. If a reasonable and accessible payment method is established, then fraud and abuse in the organization will then start to diminish.