Saturday, November 8, 2014

Enabling/Scamming and Fraud in Health Care

There's no such thing as free money.
This past week I was alerted to a situation where a chronically ill person was being used as a conduit to obtain goods and services for their family. The person thought they were helping by “fronting” for their family,  not realizing that they were not only enabling adult children, but they were putting themselves in jeopardy.

As if to prove a point, a day later I learned of another similar situation, but in this case, those cutting the check had caught on and they came down very hard with little regard to the impact this would have on the person. Bottom line - if you are caught inappropriately using or abusing state and federal services or even local charities, the hammer falls swiftly and can have very damaging effects.

So what types of things can get you into trouble? Getting money from a local charity to pay the rent, fuel, utility bill and using it for something else. Hiding income in order to qualify for state, federal and/or local program. Turning benefits (such as food stamps) into cash.

There are people who spend hours figuring out how to “work the system,” justifying it by saying, “everybody does it.” Fact is, not everyone does it and because those that do it create such a problem, the process of qualifying for certain types of services has become so complex, many of those who could benefit don’t bother.

Also disturbing are people and organizations that knowingly dupe the public. This can range from the “snake oil salesman” promising “cures” to the “charities” that are nothing more than fronts to raise money for solicitors and not benefiting those who are in need. America’s Worst Charities list organizations like Cancer Fund of America, American Breast Cancer Foundation, and Breast Cancer Relief Foundation in the top 10 of the 50 Worst Charities in America

According to the National Health Care Anti-Fraud Association (NHCAA), the financial losses due to health care fraud are in the tens of billions of dollars each year. A very small minority of dishonest health care providers commits the majority of health fraud, yet the impact is huge. Common types of fraud include: billing for services and goods that were never rendered; “upcoding,” billing for more expensive services than were actually performed; performing unnecessary tests and services to generate insurance payments. Not only does this result in higher health insurance premiums, it can have very negative effects on patients, including physical risk from unnecessary tests, treatments and other procedures. Learn more by going to the NHCAA site.

Needless to say, the more complex our health care and social services become, the more advances made to extend life, the more scamming and fraudulent behavior seems to be appearing.  These issues are so prevalent in health care that a week doesn’t go by that I have some form of discussion about this. That noted, there are things that each of us can do to help reduce it.

 Consider the following:
• We live in a materialistic society where having more is believed to be better. Learning to live within your means is a critical skill we all need. 

• Helping others makes us feel better, so it’s natural that we want to do it. Yet, we can over do it and become enablers creating negative consequences for all. Learn more by reading Pathological Altruism: Giving That Hurts.

• To protect yourself from being scammed by a charity, follow the guidelines for “Don’t get fooled by bad charities.”

• Prevent Health Care Fraud by treating your health insurance ID card like a credit care. Report fraud. Review your medical bill each and every time you receive it. Look for charges for services you didn’t receive; billing for the same thing twice and services that were not ordered by the doctor. Since many people have life time caps on their health insurance policy, “upcoding” could end up robbing you of health care reimbursement down the road. For more information on this topic read 12 Tips to Protect Yourself from Health Fraud 

• Because those with chronic conditions are often at high risk for being the targets of charlatans promising false “cures,” be sure and read If it Sounds to Good to be True: Scams, Frauds and Quacks 

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