Statistics
Despite the intention to create a perfect or at least equal healthcare system in the United States, such issues as fraud, waste, and abuse might challenge the population and should never be ignored. According to LaPointe (2017), fraud and abuse in the healthcare sector cost the country billions of dollars. For example, more than $3.6 trillion was spent to represent insurance claims related to fraud and abuse in 2018 (National Health Care Anti-Fraud Association [NHCAA], n.d.). The economic burden of medical waste is about $760-935 billion annually, which is 25% of US healthcare costs (Hughes & Meadows, 2020). There is a chance that medical fraud, abuse, or waste affects every American, and it is necessary to understand how to combat these problems.
Barriers to Addressing the Issue
Developing detection and prevention policies is not always easy for healthcare organizations. Suppose providers have already focused on specific priorities, like medical billing or care delivery. In that case, it is difficult for them to consider all fraud and abuse laws at national and local levels. Kickback acceptance, falsifying diagnoses to prescribe expensive medications, and executing unnecessary services to create insurance payments are widespread examples of medical fraud associated with abuse and waste (NHCAA, n.d.).
Financial Impact
The financial income from such behaviors is that “the United States spends nearly twice as much per capita as other high-income countries” on medical care with little or no improvements in population health outcomes (Speer et al., 2020, p. 1743). These examples and undeniable data prove that the US healthcare system requires additional strategies to control waste, fraud, and abuse.
Possible Solutions
Currently, the country has already taken several steps to manage provocative situations. For example, the Federal False Claims Act and the Anti-Kickback Statute impose civil liability to predict illegal procedures, and the Physician Self-Referral Law forbids healthcare providers from making referrals without compensation agreements (Drabiak & Wolfson, 2020; LaPointe, 2017). Finally, it is essential never to forget the essence of the Hippocratic Oath, ensuring all services are ethically and legally approved, eliminating fraud, abuse, and waste in the US healthcare system.
References
Drabiak, K., & Wolfson, J. (2020). What should health care organizations do to reduce billing fraud and abuse? AMA Journal of Ethics, 22(3), 221-231. Web.
Hughes, D. L., & Meadows, P. D. (2020). Reducing medical waste to improve equity in care. American Journal of Public Health, 110(12), 1749-1750. Web.
LaPointe, J. (2017). How providers can detect, prevent healthcare fraud and abuse. Revcycle Intelligence. Web.
National Health Care Anti-Fraud Association. (n.d.). The challenge of health care fraud. NHCAA. Web.
Speer, M., McCullough, J. M., Fielding, J. E., Faustino, E., & Teutsch, S. M. (2020). Excess medical care spending: The categories, magnitude, and opportunity costs of wasteful spending in the United States. American Journal of Public Health, 110(12), 1743-1748. Web.