National Healthcare Fraud

  Introduction

There is a growing concern in the country regarding losses caused due to fraud, waste and abuse of resources and services in the health care system.  According to NHCAA (National Health Care Anti Fraud Association) the losses caused due to health care fraud is an estimate of 60 billion dollars a year (Robles, 2009 ).

  It has become imperative that immediate steps be taken to prevent FWA as   the cost of health care escalates every day.  Various strategies include: increase in the investigation efforts at the grass roots level and implementation of technology to enhance data security and integration

The government of US  has  made a conscious effort  and  has invested  a considerable amount of the taxpayers money  in taking effective steps to prevent  fraud , waste and abuse in the government’s  largest  provider of health care insurance programs : Medicare and Medicaid.

There are several legislations that have been passed to prevent FWA in the health care system and by health care providers and various programs have also been established for this purpose.   CMS,  HHS and other government organisations are dedicated to implementing these programs.

Methodology 

The methodology of collecting data has vastly been electronic, as the sources for data and information regarding the subject is easily available on the internet and as these are primarily government sources the security of the data source is validated.

Hypothesis:

A review on the performance of the,US  Department of Health and Human Services and CMS in preventing fraud waste and abuse and  whether CMS has been successful in preventing FWA in the health care system.

Centers for Medicare and Medicaid Services

The Centre for Medicare and Medicaid Services oversees the nation’s largest health insurance programs: Medicare and Medicaid, CMS is a part of Health and Human Services department (HHS). In its attempt to safeguard Medicare and Medicaid against fraud waste and abuse, CMS have employed PSC’s (Program safeguard contractors) in an attempt to “Detect and dether Medicare fraud and Abuse” (Hill, 2007).

Review of the CMS Performance in Fraud Waste and Abuse Prevention Efforts

1.       In an effort to prevent losses caused due to fraud waste and abuse the CMS have made it mandatory that its sponsors  ensure mandatory training of their employees under 42 CFR parts 422.503 and 423.504 and require that: