The US healthcare system is serviced by many district establishments. These organizations serve as the hub for all people who require healthcare and are eligible for US healthcare benefits. The healthcare infrastructure is mainly supported by three parties- Government funded, non-profit and private operating parties. The US Government spends roughly 17.1% of its total GDP on healthcare in 2014. The healthcare system has no central authority- and is operated by various public and private organizations. Private health care companies include big names like United Health Group and Cardinal Health. While the government money is mainly spend through organizations like Medicare and Medicaid. Unlike various other developed nations, USA doesn’t have universal healthcare plans. As a result, their system doesn’t cover any uninsured person or foreign visitor.
Few achievements of US healthcare
- The human life expectancy rate has increased by 3.2 years over the last decade.
- Higher standards for practicing medicine. This results is better doctors.
- Better healthcare services
Though the US healthcare system supports many people, it still has its flaws. Healthcare frauds are very common in America. As a result of these frauds, the country lost 3.8% of its total budget to healthcare frauds. Many researchers believe that frauds amount to 10% of total claims. The country loses a lot of money in healthcare frauds, which could have been used for better purposes.
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How a fraud takes place in healthcare-
Most of the frauds are committed by a small majority of healthcare service providers. Their basic aim is to charge the healthcare provider for services that were never given. Few instances of healthcare fraud are discussed below-
- Billing a patient for services that were never given. In this way, the care giver receives the money even though no services were given. Usually this process is done with the help of real people, using their identity and then giving them kickbacks. Also, a care provider might forge the documents or use identity theft to fake a person’s credentials.
- Billing an amount which is greater than what is spent- One of the most common ways of healthcare fraud. Patients or their families often don’t check the bill while checking out of a hospital or care center. The organization might overcharge them, getting extra money for services that were never rendered.
- Unbundling the bill- Most healthcare giving organizations bill a patient in one step, which saves money as individual processes cost more. However, certain institutions might bill their patients at every step of their stay in hospital.
How to detect frauds?
Every time a fraud is committed in US healthcare, an insured person loses their benefit. Since most people have a limited or capped insurance cover, any medical bill that is generated on their name counts towards that cap. So if a person is defaulted by fraudsters, they might end up losing the entire cover plan. Also, since most families are insured under the name of the father(or who so ever has their insurance provided by employment) any loss to the healthcare system directly affects millions of families.
