Part 1Fraud medical billing can be described as the act of filing false medical cost reports, billing for healthcare services that are not provided, up coding and consequently overutilization amongst other acts of healthcare frauds (Henry, 2015). Consequently, studies have proved that the underlying rates of medical frauds have increased lately to an extent of even surpassing drug dealings. Despite the fact that various provisions have been made to address the issue of medical frauds, it is discouraging to state that the problem has grown into a major corruption issue that has affected the reliability of healthcare services over the recent years. More specifically, patients have been forced to cater for healthcare services that are not helpful to their underlying health issues and situations that have adverse implications to their general healthcare outcomes (Henry, 2015).
The issue being addressed has been a stumbling block in the establishment of a transparent healthcare sector for the people of the United States and the world as a whole. Studies have proved that the underlying implications of fraud medical billing have rose to unmanageable heights lately despite the measures that have been put in place to address the problem (Henry, 2015). More importantly, fraud medical billings have affected the underlying nursing professionalism and competence that have been redirected at boosting the general patient outcome as a whole. For instance, the illegal healthcare practice has adverse effects on collaboration healthcare practices that form crucial pillars in the provision of healthcare services to the patients (Healthcare Fraud, 2016).
It should be noted that team work and collaboration is effective in the sense that it provides the nurses with opportunities of sharing their nursing experiences with their counterparts with the core goal of ensuring that the patients are provided with quality services that are entirely helpful to them (Henry, 2015). However, it is fundamentally devastating to state that there are no better ways of working for the better good of the patients other than by ensuring that they are provided with quality healthcare services that they deserve. Thus, the fact that healthcare and medication frauds affect the different aspects of quality healthcare services that are provided by hospital and clinical settings means that it should be addressed whatsoever. On that regard, it is logical to state that other than preventing healthcare accessibility that is being apprehended in the current society, medical frauds have also been unimaginable approaches that have been affecting the quality of healthcare services that are provide to the patients under different healthcare contexts (Healthcare Fraud, 2016).
Far from that, it is also worth to state that healthcare frauds have compelled individuals to redirect their focus on individual nursing practices because it provides them with remarkable platforms for foreseeing their illegal nursing practices (Carlson, 2011). It should be noted that the increase in healthcare frauds have led to the development of techniques that can be used to address the issue of medical frauds including the designing of computer software that can account for the healthcare services that are offered to the patients. Thus, a majority of healthcare providers who uphold medical frauds are also associated with involvement in fraud issues under individual healthcare contexts. On the contrary, patients should be advised to seek public healthcare services at the expense of choosing individual healthcare services because of the underlying fraud practices that are associated with the services.
There are various ethical and legal implications that are associated with involvement in medical frauds. To begin with, it affects the quality of healthcare services that are provided to the patients. Nurses and other healthcare providers tend to engage themselves in activities that are against the standardized procedures of nursing practices (Healthcare Fraud, 2016). Far from that, it is also illegal to charge the patients for healthcare services that they do not receive. Thus, other than acting against that primary nursing practices that defines the duties of the nurses; fraud medications also affects the legal justifications which states that patients should be provided with quality care and concern in their healthcare endeavors (Henry, 2015).
- Carlson, J. (2011). GAO blasts CMS for fraud-fighting tool delay. Modern Healthcare, 42 (29), 12-13.
- Healthcare Fraud,. (2016). Understanding Healthcare Fraud. Available at http://www.bcbs.com/report-healthcare-fraud/?referrer=https://www.google.com/
- Henry, P. (2015). Biggest healthcare frauds in 2015: Running list. Available at http://www.healthcarefinancenews.com/slideshow/biggest-healthcare-frauds-2015-running-list