Fraud and Abuse in Health Care


The relevant article carries out a detailed examination of healthcare fraud and abuse. According to the author’s consideration, fraud is defined as an intentional and willful act of deceiving, closely connected with the misrepresentation of medical services. The word “abuse” is also widely used in this context, but unlike fraud, it is related to unintentional acts committed. The significance of this problem can be observed through the repercussions of healthcare fraud: patients pay for the services which are not provided; the information in medical record documents is corrupted. This kind of activity might hurt the patient’s condition.

We will write a
custom essay
specifically for you

for only $16.05 $11/page
308 certified writers online
Learn More

As a result, it is critical to work out a consistent strategy aimed at preventing healthcare fraud and regulating the cost of services so that it meets the actual price of the provided office.


Fraud Issues

The article provides a detailed description of the concepts of fraud and abuse, supplying it with the relevant examples. First, and foremost, the authors put a particular emphasis on the psychological implications that the relevant issue contains. Thus, it is critical to differentiate between intentional and unintentional activity as this is the basic point that separates fraud from abuse. The psychological impact might be, likewise, analyzed from the customers’ standpoint. Thus, in case, patients face such treatment, their level of trust in medical services falls, and they might not want to address these organizations (Rudman, Eberhardt, Pierce, & Hart-Hester, 2009).

It is also significant to point out the physical complications that health care fraud might cause. Hence, for instance, in the Raritan Bay Medical Center’s case, large scope of patients was deprived of receiving the essential services due to the unjustly raised costs. It is reasonable to assume that the condition of a particular percentage of these people declined because of the illegal activity of the company.

Ethical Issues

The authors, likewise, focus on the ethical side of the question under discussion. Thus, they believe that suppliers and clients mustn’t participate in any activity that has fraud or abuse implications. The examples provided in the case study show that the issues of fraud might be the result of both poor individual and corporate morality. As a result, the authors suggest that healthcare organizations provide appropriate education and training programs, establish fraud and abuse committees, and use data mining and modeling software (Rudman et al., 2009).

It is essential to note that the proposed ethical solution is widely discussed in the relevant literature. Hence, Harper considers corporate education to be one of the most efficient measures in fraud prevention (Harper, 2013).

The article also points out the moral obligations that the federal government ought to bear in terms of prosecuting providers, healthcare organizations, individuals committing fraud, and abuse regularly.

Get your
100% original paper
on any topic

done in as little as
3 hours
Learn More

Patient Rights

There are several measures that one can employ if being a part of the Doctor’s team. Thus, some specialists believe it is important to contact a medical billing advocate or the fraud investigation bureau of the state (Bernstein, 2014). Moreover, it is critical to assure that the cases of fraud are not ignored within the workforce. Thus, employees need to be prepared to report on suspicious activity and fraudulent practices.

Finding a solution is more complicated in terms of abuse issues. According to experts’ evaluation, abusive behavior is normally the result of an employee’s ignorance (Thornton, Mueller, Schoutsen, & van Hillegersberg, 2013). As a consequence, the abuse problem is best addressed by providing relevant education and training for the team members.

Critical Evaluation

The analysis of the case study shows that there is a large scope of measures that can be employed to reduce fraud practices. One of the alternative solutions is sentencing and implementing fines. In the meantime, practice shows that even though these methods are generally effective, they cannot resolve the problem completely.

Hence, from the moral perspective, health care workers should not commit any fraud actions due to their ethical code but not the fear of potential punishment. Specialists point out the necessity to improve corporate morality and ethics that can prevent the staff from illegal actions (Lee, 2014). Therefore, a complex approach is essential in reducing fraud and abuse.


The article under analysis points out the acute problems that exist in the healthcare sphere. One of the key messages of the case study resides in the fact that some of the people who work in the related area fail to fulfill their legal and moral responsibilities, which results in a negative impact on the customer’s health and psychology.

The majority of experts agree on the point that the situation might be improved with the implementation of a complex approach to the issue (Bernstein, 2014). In other words, the preventative measures should include standard punishments such as sentences and fines along with the relevant educational programs. It is most critical that the problem is managed at every level from a particular practitioner to the government.

Reference List

Bernstein, J. (2014). Defending Waste, Fraud, and Abuse. Clinical Orthopaedics and Related Research, 472(8), 2329-2333.

We will write a custom
for you!
Get your first paper with
15% OFF
Learn More

Harper, G. (2013). Trust Me I’m a Doctor: The Struggle over Scope of Practice and Its Effect on Health Care Fraud and Abuse. DePaul Journal of Health Care Law, 237(1), 1-15.

Lee, N.R. (2014). The Changing Face of Healthcare Fraud and Abuse in America. Web.

Rudman, W.J., Eberhardt, J.S., Pierce, W., & Hart-Hester, S. (2009). Healthcare Fraud and Abuse. Perspectives in Health Information Management, 6(1), 1-24.

Thornton, D., Mueller, R.M., Schoutsen, P., & van Hillegersberg, J. (2013). Predicting Healthcare Fraud in Medicaid: A Multidimensional Data Model and Analysis Techniques for Fraud Detection. Procedia Technology, 9(1), 1252-1264.

Print Сite this

Cite this paper

Select style


StudyCorgi. (2020, December 26). Fraud and Abuse in Health Care. Retrieved from

Work Cited

"Fraud and Abuse in Health Care." StudyCorgi, 26 Dec. 2020,

1. StudyCorgi. "Fraud and Abuse in Health Care." December 26, 2020.


StudyCorgi. "Fraud and Abuse in Health Care." December 26, 2020.


StudyCorgi. 2020. "Fraud and Abuse in Health Care." December 26, 2020.


StudyCorgi. (2020) 'Fraud and Abuse in Health Care'. 26 December.

This paper was written and submitted to our database by a student to assist your with your own studies. You are free to use it to write your own assignment, however you must reference it properly.

If you are the original creator of this paper and no longer wish to have it published on StudyCorgi, request the removal.