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hello please see attached assignment I need help with thanks Health care fraud is a kind of white-collar crime that consist of the filing of

hello please see attached assignment I need help with thanks

image text in transcribed Health care fraud is a kind of white-collar crime that consist of the filing of dishonest health care claims in order to turn a profit. Fraudulent health care schemes can transpire in many forms such as Practitioner schemes which include: individuals obtaining subsidized or fullycovered prescription pills that are actually unneeded and then selling them illegally on the black market for a gain; billing by practitioners for health care that they never rendered; filing duplicate claims for the same service rendered; altering the dates, description of services, or identities of members or providers; billing for a non-covered service as a covered service; modifying medical records; intentional incorrect reporting of diagnoses or procedures to maximize payment; use of unlicensed staff; accepting or giving kickbacks for member referrals; waiving member co-pays; and prescribing additional or unnecessary treatment. Members can commit health care fraud by providing false information when applying for programs or services, forging or selling prescription drugs, using transportation benefits for non-medical related purposes, and loaning or using another's insurance card. (Cornell Law). According to the Federal Bureau of Investigation (FBI), beneficiaries should always be aware of potential fraudulent activities when dealing with medical providers whether it's through the internet or during their normal daily activities. Since many health care fraud involve the theft of patients' medical information which is then used in schemes to obtain reimbursement for services and goods never rendered, it is very important to know who you are dealing with and why. The FBI provided some of the most common methods used by criminals to fraudulently obtain patient insurance information. Some of these methods include: (1) providing an incentive such as money or a gift, to beneficiaries to visit a location where identities are obtained when the patient signs in. (2) Obtaining patient information when patients obtain a free screening, a method frequently seen at health fairs. (3) Inducing medical personnel with access to patient insurance information to copy the material and provide it to those involved in fraud schemes. (4) Purchasing the information from others involved in fraud, including owners of fraudulent companies and marketers of stolen patient and physician billing information. The FBI offers a few tips on how to protect yourself and information from unscrupulous heath care fraudsters. These include: (1) Safeguard insurance cards and benefit information. Make sure there is a legitimate reason to provide your insurance card or insurance information to others, and be especially vigilant if your information is requested when services are offered for free, or any offers are made during telemarketing calls. (2) Be aware of gifts or other inducements from visiting medical providers. Don't accept unnecessary equipment or products, and report any suspicious or unusual activity. (3) When receiving medical supplies, be sure to check that you were sent what actually was orderedfor example, instead of a power wheelchair, you receive a much cheaper scooter. (4) Be aware of your surroundings in medical facilities. For example, when completing a physician visit, be wary of a medical office that lacks normal medical equipment, or if personnel fail to conduct normal patient health checks, like taking your temperature and blood pressure. Required 1. I need help rephrasing the highlighted lines 2. Use the fraud triangle to evaluate the fraud and prepare a description of the characteristics of the typical fraudster who might commit health care fraud. This was the original question Explain how the health care fraud could be conducted and discuss the FBI's tips for preventing health care fraud from occurring. Use the fraud triangle to evaluate the fraud and prepare a description of the characteristics of the typical fraudster who might commit this fraud. Please note I need an original not another student work and please use the FBI website for reference. Thanks The Fraud triangle is a framework designed to explain the reasoning behind a worker's decision to commit workplace fraud. The framework comprises of three stages which classified in relation to the effect on the individual they include pressure, opportunity, and rationalization. The fraud usually results from the pressure on the physician's personal financial problems such as debt as well as from workplace liabilities such as a decline in revenue. In addition, the physicians have adequate opportunity to commit fraud through less stringent organization policies that create loopholes for theft. For example, when doing purchasing of an equipment the follow-up procedure are not effective which facilitates the collusion with the suppliers to benefit from the contract. The physicians abuse their position to solve the perceived challenging financial issues in a manner where a gain is realized. Moreover, under the final stage of fraud triangle which is the ability to rationalize the Medicare fraud. The fraudster who are the physicians justifies the fraud in a way that is acceptable to his or her internal moral compass. For example, the documents are well filled in and dated which minimizes the chance of any discovery. In some critical condition, even the top officials are involved which makes the fraud look more of a genuine normal office practice. Usually, the fraudster will be characterized by some traits which include that they are a high-risk taker and find no big deal in breaking the rules and they take chances. In addition, they are hardworking where they are usually the first ones to arrive in the morning and the last to leave at night and they rarely take vacations of the hospital. However, most of the physicians are usually under stress where they suffer from a personal crisis such as a financial challenge or a bad marriage. Furthermore, they educated persons and majority are men where research shows that losses caused by men were nearly four times those caused by women. Moreover, physicians at high ranks of authority conduct frauds that are four times those caused by their juniors

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