Opportunity and Prospective Fraud

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Submitted By Brody78
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Opportunity Perspective for Fraud 1

Running Header: OPPORTUNITY PERSPECTIVE FOR FRAUD

Opportunity Perspective for Fraud

Opportunity Perspective for Fraud 2

Health care fraud, categorized under white-collar crime, refers to the filing of false health claims to get a profit. This is done when corrupt and untruthful provider or member maliciously submits or makes someone else to file information that is misleading. There are many forms of such deceptive health care schemes where a health care practitioners and members are involved. The opportunity to commit frauds specifically in the healthcare in industry is considered to be looking any employee in the eye due to the ease of getting away with it. With the ethical and moral issues that have plagued the healthcare industry the commission of fraud by my healthcare workers is one of the most common. Too many cases of healthcare fraud had been done unnoticed and so many healthcare workers have become rich. While there are some fraudulent activities that have been caught, there are still many opportunities that present themselves for every healthcare worker and professional to challenge their ethics, morals, and values.

One example of a health care fraud by a provider involves billing patients for services that were never rendered to them. Some doctors would send Medicare or Medicaid a bill for a clinical procedure that never happened. Dentists bill for extractions that were not performed, or nursing homes may bill for supplies that were not bought or used. With the bills submitted, false receipts or records are made to back up these claims. Billing for procedures or services that are unnecessary can also be another type of fraud. According to Cady (2007, p. 57) these facilities (hospitals,…...

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