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What Is Health Care Fraud? November 24, 2019

Health care companies receive millions, if not billions, of health insurance claims for affordable and quality care. It has been revealed that a small percentage of these annual claims are fraudulent. However small the fraudulent claims, the government loses lots of money because of it. This criminal offense is the reason for the rise of health care fraud attorneys.

Who commits health care fraud?

A majority of health care plan holders and health care providers are culpable. Examples of health care providers are dentists, doctors, pharmacies, and the likes. Even worse, people who willingly give out their insurance information may fall victim of health care fraud since their identity has been compromised. Such individuals may hire a health care lawyer if they are innocent. Check here!

Types of health care fraud

As health care fraud involves dishonest individuals, culprits are likely to devise many ways to commit this crime. From hacking into medical records to duplicating procedures and submitting false claims, health care fraud varies in type.

The NHCAA, an acronym for National Health Care Anti-Fraud Association, categorizes health care fraud accordingly:

Health care providers commit frauds through:

  • Fraudulent medical billing, especially overcharging for excess services
  • Phantom billing – Billing medical procedures that were not performed
  • Prescription drug fraud – Concocting false diagnosis to justify unnecessary tests
  • Upcoding – Misrepresenting covered procedures as uncovered ones

Patients commit frauds when they:

  • Fill claims for prescriptions or medical procedures they didn’t receive
  • Forge health care bills to get reimbursements
  • Falsify their identity by using a fake insurance card
  • Peddle prescription drugs

Penalties and consequences of health care fraud

Health care fraud attorneys, according to the Health Insurance Portability and Accountability Act (HIPAA), may regulate the consequences of violating health care insurance claims. By confirming the criminality of the act, the HIPAA will prosecute offenders accordingly. If found guilty, the offender could face drastic consequences ranging from substantial fines to jail time. If the crime has led to the death of a patient, the offender may serve life imprisonment in federal prison. Other penalties include probation, loss of medical license, criminal charges, and seizure of assets, to mention a few.

Avoiding health care fraud

It is pertinent to prevent health care fraud since naivety is not an excuse in the court of law. A cankerworm in health care infrastructure, big agencies such as the FBI and FDA are adequately cracking down on health care fraud. Hence, everyone must avoid it by carrying out the following:

  • Stay informed – You must be aware of every medical procedure you’re entitled to, and document procedures for future purposes.
  • Protect health care credentials – Safeguarding your ID starts with preventing the illegal use of your insurance cards. Since your identity can be used to seek medical services and peddle prescription drugs on the internet, you have to ensure your card is protected at all times.
  • Report fraud – If, at any point in time, you detect fraudulent health care activities, inform your health insurance provider immediately. And endeavor to report card or identity theft to law enforcement officials, as well.

Sometimes, health care frauds are difficult to understand without proper guidance. In case you’re suspicious of a scam, a health care fraud attorney or health care fraud lawyer can represent you in court. Click here for more information: https://smallbusiness.chron.com/concept-fraud-healthcare-industry-71970.html

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5 HEALTH CARE LAWS PROTECTING THE RIGHTS OF PATIENTS August 3, 2018

INTRODUCTION

Health care providers face substantial legal challenges under the Affordable Care Act(ACA). Sweeping reforms have created a demand for health care law specialists. As a result, it is the fastest growing law practice in the United States.The current environment requires a renewed focus on the part of health lawyers. Health care lawyers must understand what is happening in the administrative, ethical and legislative components of the health care field to perform proficiently.The following five laws highlight a few of the most recent and significant game-changing regulations in the health care field.

 

EMERGENCY MEDICAL TREATMENT AND ACTIVE LABOUR ACT (EMTALA)

The Emergency Medical Treatment and Active Labour Act took effect in 1986 with congressional sanction. The law requires care providers to deliver medical services despite the patients’ ability to pay specifically emergency services. If an individual has a medical emergency, such as an injury or active birth, the law makes it obligatory for caregivers to stabilize the patient and provide treatment up to the point where the client is stable. If the care provider cannot deliver this service, the law mandates that the provider transfer the patient to a capable facility.

 

THE STARK LAW

The Stark Law prohibits care providers from referring a patient to a peer or family member but does provide for specific exceptions.This law applies to civil cases and exposes violators to False Claims Act culpability. The Stark Law encompasses referrals to primary care providers for specific health services and does not require prosecutors to prove intent for overpayments. However, prosecutors must prove intent for intentional violations involving punitive recovery. See more.

 

THE HEALTH INFORMATION TECHNOLOGY FOR ECONOMIC AND CLINICAL HEALTH (HITECH) ACT

This was created to promote effective technology implementation among care providers. It addresses privacy and security of electronic health records. The act also reinforces parts of the civil and criminal sections of the Health Insurance Portability and Accountability Act (HIPAA).HITECH outlines four liability levels, each with increased punishments. Offenders who violate the law unknowingly, initially receive the lowest fine and the opportunity to correct the offense in 30 days to avoid fines completely. The minimum penalty increases greatly between each level.The maximum fine amounts to $1.5 million. The health care fraud attorney handles this.

 

THE GENETIC INFORMATION NONDISCRIMINATION ACT OF 2008

Genome sequencing and other scientific developments have enabled researchers to produce incredible medical breakthroughs. While certain gene identifiers do not reveal ethnicity, some genetic traits emerge only among specific ethnic groups. Since discrimination occurred, the federal government created the Genetic Information Non-discrimination Act to prevent employers and insurance agencies from discriminating against individuals based on genetic testing outcomes. It forbids health insurance and employment discrimination based on genomic information.

 

CONCLUSION

Health care innovation moves at such a tremendous pace that even the most legally sound care providers have difficulty keeping up with legal issues. As care providers settle in with new payment models, they will demand more health care legal professionals to keep organizations up-to-date and compliant with the law. Check out this site: https://federal-lawyer.com/after-federally-indicted-options/

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10 Things Pre-Boomers Need From Health Care Reform November 7, 2016

Health Care

With several bills coming out of both houses of congress, the health care discussion by health care lawyers appears to be far from over even though the administration wants legislation signed this year. The politics of reform are intensifying each passing day. Therefore, without regard to party affiliation, I’ve tried to identify key points for pre-boomers to consider when it comes to health care reform.

The following 10 points are in no particular order.

And, I purposely do not take into consideration what other age or demographic groups may want or need. As a pre-boomer, I believe the items listed below are, or should be, the deal breakers in any health care bill offered to my generation (those born between 1930 and 1945).

1. Ability to keep current doctor(s) and be able to visit them as needed.

2. Assurance of complete and consistent health care until death.

3. Portability of insurance, because seniors do move.

4. Coverage will not be given other groups at the expense of seniors.

5. Allow competition among insurance companies so premium costs can be lower.

6. Insurance companies cannot cancel secondary coverage no matter what.

7. No extra premiums or denials for pre-existing conditions.

8. Any reform must be deficit neutral to keep taxes from going up.

9. Test proposed plan elements rather than initiate immediate, sweeping changes.

10. Eliminate Medicare and Medicaid waste, fraud and abuse, as promised.

Reducing Medicare and Medicaid funding by over $600 billion in order to provide insurance for those currently not covered is not going to fly with most new seniors, certainly not this one. Don’t you wonder how many people are truly uninsured because they can’t afford the premiums or have pre-existing conditions versus those who, for whatever reason, choose not to buy insurance or are here illegally?

The notion that more than a half a trillion dollars in saving can be achieved by reducing waste, health care fraud and abuse is highly questionable. And if it were true, why didn’t the government take steps to realize these savings before the current debate heated up? So someone needs to identify the problems and fix them now.

There have been many implied promises but no guarantees that seniors will not be placed on some kind of rationing or other changes which result in reducing the quality of our health care and health care fraud in the years ahead. So we must be skeptical until the details are revealed.visit site from http://www.wsj.com/articles/worst-performing-stocks-of-2016-health-care-1478433602 for more info.

Health CareIn the meantime, keep the pressure on our representatives in Washington. Ask how they intend to deal with the above 10 points, plus any others you can think of. If we are respectfully persistent with questions, maybe the politicians will get the idea that pre-boomers are serious about our health care coverage. However, should they not be responsive to our needs, and then we don’t need them anymore. And we’ll vote for someone who is willing to listen to the generation of new seniors.

Don Potter, a Philadelphia native, was born in 1936 and is a 50 year veteran of the advertising agency business. Now living in Los Angeles, he has written two novels in retirement, frequently writes on marketing issues, and has a blog dedicated to pre-boomers (those born between 1930 and 1945).

Read more articles for and about pre-boomers with thoughts, comments and opinions designed to spark thinking, foster discussion, and stimulate debate by logging on to this link.

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