Thomson Reuters

Fraud And Abuse A Major Reason For Waste In The Us Healthcare Spending

Posted on by blogger

Health care fraud and abuse is an important and conspicuous factor in the resource and finance drain in the US healthcare system and is responsible, to an extent, for the escalating healthcare costs.

According to a report by Thomson Reuters on US healthcare spending, the US healthcare system wastes between $505 billion and $850 billion every year, out of which the waste caused due to Fraud and abuse constitutes $200 billion, or 22% of healthcare waste every year.

The following chart shows the percentage of waste caused due to different parameters in the US healthcare spending.

Source: Healthcare analytics, Thomson Reuters

What is healthcare fraud and abuse?

Health care fraud is a criminal act in which a consumer or physician(s) deliberately misrepresents facts or information, for the purpose of undeserved or greater reimbursement. Health care abuse is a reckless disregard or conduct that goes against and is inconsistent with acceptable business and/or medical practices resulting in greater reimbursement.

How to prevent it?

Health care fraud and abuse has played such a vital role in increasing the cost of health care and has become a pertinent issue for the government as well as the general public. The question is how to prevent it?

Both Consumers and physicians have to be alert to the possibility of fraud and abuse and work to prevent it. Consumers need to get involved with their health care beyond the point of going to the doctor and taking medication. They need to be educated on their insurance plan, how much they pay, the proper names of their ailments, and they need to keep track of the services they receive and why they receive them. Simple tips that may help prevent fraud and abuse include:

“Review Explanation of Benefits to ensure accurate dates of service, name of providers, and types of services reported
“Protect insurance card and personal information at all times
“Count pills each time they pick up a prescription
“Research providers with state’s medical boards
“Report suspected fraud and abuse as soon as possible

Along with consumers, physicians too must check for any unintentional fraud and abuse happening around them. They can have training and awareness amongst their staff to prevent unintentional fraud. These joint efforts would definitely check the fraud and abuse rate in the United States and ultimately bring down the overall cost of healthcare.

For more Information visit: Phoenix Medical Billing (), San Diego Medical Billing () , San Francisco Medical Billing ()

A Majority Of Physicians Oppose US Healthcare Reform

Posted on by blogger

Healthcare reform is a highly debated topic these days, due to new legislation passed by President Obama late last year. Although the American public seems to be divided in their stance on the reform act, the now majority Republican-controlled House is not its only critic- a recent study cites that many physicians themselves are actually opposed to the reform efforts. Among the major points made, physicians polled feel that reform calls for a greater number of healthcare workers, many of whom are not required to earn doctorate-levelhealthcare degrees like nurse practitioners and physician assistants.

The report recently released by Thomson Reuters and HCPlexus details the results of a national survey which polled nearly 3,000 U.S. physicians on the issue of healthcare reform. The overall consensus can be generalized to say that a majority of physicians feel “frustration and dismay in a time of change.” ”

Of the physicians polled,

65% believe that U.S. healthcare will deteriorate with five years
18% believe it will improve
17% believe it will stay the same

If the healthcare reform act passed by President Obama remains in legislation, under the Patient Protection and Affordable Care Act (PPACA), an estimated 32 million currently uninsured Americans will have will access to healthcare. Physicians participating in the survey report concern over who will treat these new patients. Nurse practitioners and physician assistants will likely begin seeing and treating nearly as many patients as physicians themselves.

According to the report, “physicians overall have a clear frustration with the non-physician providers’ compensation, which is comparable to primary care physicians, citing that nurse practitioners and physician assistants are not as well-trained or as educated.”

Nurse practitioners and physician assistants do have an education above a bachelor’s degree, but are not required to have earned their doctorate from a medical school like a physician.Healthcare degrees of all levels are in high-demand in response to reform efforts, which will require greater numbers of healthcare workers overall, in both an administrative and clinical capacity. Online programs offering advanced healthcare degrees are growing in popularity as a method for working healthcare professionals to earn the additional credentials necessary to qualify for higher-level positions.

Results of the study also claim that a majority of physicians have a similarly cynical view on how healthcare reform will affect patients. Results conclude that:

58% feel the legislation will negatively affect patients
27% feel the effect will be positive

Survey results distinguished responses among physicians of different medical practices, for example, as primary care physicians, or psychiatrists. Of all participating groups, pediatricians and psychiatrists were the most optimistic about the future of healthcare. On the other hand, dermatologists were found to have the most negative outlook; not a single dermatologist polled reported a belief that current healthcare reform efforts would have a positive effect on physicians.

Emily writes about Online Education for University-bound.com – a resource site for those interested in earning a degree online.