Healthcare Fraud

Question

For this assignment you will be replying to my instructor’s post she made about my post. I feel it is

important to supply you the writer more information, so you have an understanding on what Is going

on.

First will be the supplied topic we had to write about given from the professor

Next will be my paper and last will be the professors reply to me

Module 7: Discussion Forum

No unread replies.22 replies.

Because healthcare fraud and abuse have a significant impact on the U.S. economy,

healthcare organizations and professionals must be knowledgeable of fraud and abuse

and employ tools and methods to detect and prevent them. Identifying fraud and abuse,

developing prevention techniques, and utilizing detection tools enable healthcare clinics

and hospitals to optimize financial success and minimize risk. Many federal entities help

ensure compliance with laws and regulations. The goal of these programs is to ensure

quality care and protection for patients.

Work through the Billing Fraud Simulation (Links to an external site.). In your initial

post, discuss your observations on the fraud and abuse potential. What are your

thoughts on the significance of billing fraud and the impact on an organization’s financial

operation?

Discussion Requirements:

Substantive peer responses ask thoughtful questions pertaining to the topic and/or

answer questions (in detail) posted by another student. Support your statements with

logic and at least one credible reference.

Health care abuse and fraud is a major problem affecting the US health sector. According to

Jesilow & Burton (2017), it is estimated that the health care department loses billions due to

fraud in their system of operation. The integrity of the health care financial operations is

questionable as the enrolment and discharge of patients do not match the financial approach they

have on individuals. Therefore, that’s an accurate indication that the patients might be paying for

their healthcare services, and money is not remitted to the healthcare facility. Also, it can be a

reflection that patients are being discharged without them meeting their medical bills (Jesilow &

Burton, 2017). Thus, this discussion post highlights the health care abuse and fraud observation

in the healthcare system and my thoughts on the essentiality of billing fraud and the effect of the

organization’s operation in the financial sector.

Observation

A thorough assessment of the healthcare system suggests various malpractices in the health

sector. The fraud happens through the misinterpretation of the healthcare workers, where they

give less of a bill than the actual required amount. The misrepresentation of the type of provided

services is the main portion that the healthcare department loses funds. The billing segment