Impact of HEAT,Strike Force,and Medicaid Fraud Control Units on health care fraud
详细信息
- 作者：LeCourt ; Julie
- 学历：Master
- 年：2013
- 关键词：Social sciences ; Health and environmental sciences
- 导师：Johnson,Shannon
- 毕业院校：Utica College
- Department：Economic Crime Management
- 专业：Law;Criminology;Health care management
- ISBN：9781303626203
- CBH：1549761
- Country：USA
- 语种：English
- FileSize：2816052
- Pages：63
文摘
The United States federal health care programs,Medicare and Medicaid,are plagued by fraud. Fraudulent individuals and criminal enterprises are pursuing the health care industry with a variety of schemes resulting in payouts of billions of government dollars to fraudulent health care claims. Congress enacted federal laws to prevent health care fraud from the schemes of fraudulent activity to federal health care programs. These laws are the backbone to programs such as the Health Care Fraud Prevention and Enforcement Action Team (HEAT),Medicare Fraud Strike Force Units (Strike Force),and Medicaid Fraud Control Units (MFCUs),which prosecute and combat fraud against federal and state health care programs. It is the collaborative anti-fraud efforts of HEAT,Strike Force,and MFCUs that safeguard federal and state health care programs. This collaborative effort among agencies resulted in stricter screening processes for medical providers and suppliers and the use of predictive and data analyses for medical claims management. The Patient Protection and Affordable Care Act (Affordable Care Act) of 2010 increased funding to these programs,resulting in an increased return on investment. The recoupments of funds from prosecutions,fines,and restitution are deposited back into the Medicare Trust Fund where the funds can be used for the intended purpose: providing hospital,medical,and prescription drug benefits. Although there is not a standard measurement of health care fraud,this paper will illustrate that HEAT,Strike Force,and MFCUs has had a positive impact on health care fraud. Keywords: Economic Crime Management,Dr. Shannon Johnson,Social Security,ethics,insurance,deception,regulation.