H. R. 4401, the Protecting Seniors Health Care Fraud Act
Policy in the Field of Health
Protection of Seniors from Health Care Fraud Act (H.R. 4401) is the policy that I have chosen to advocate for. Medicare fraud, waste, and abuse can manifest themselves in a variety of ways, but they all result in some type of monetary loss in certain circumstances (Bauder & Khoshgoftaar, 2020). According to the website (Congress.gov), “A report on healthcare fraud schemes that target seniors and the steps that are being taken to combat such schemes is to be transmitted to Congress by the Secretary, acting through Office of the Inspector General of the Department of Health and Human Services, and the Attorney General, in connection with the Health Care Fraud and Abuse Control Program established under section 1128C. As a result of the fact that elders require more healthcare services than the general population, seniors are more vulnerable to fraud than the general population ” (2021).
Affirmative Evidence to Support the Proposed Policy
It has been my experience that Medicare fraud among seniors has been a persistent problem in healthcare institutions for many years. According to Stowell et al. (2020), some of the most important healthcare fraud financial recoveries are related to seniors, with the majority of these recoveries owing to the Medicare and Medicaid programs, among other sources. According to the information presented, the federal government obtained or negotiated a total of $2.3 billion in healthcare judgments and settlements in 2018 through its Healthcare Fraud and Abuse Control program. The Medicare and Medicaid programs accounted for $1.4 billion of the total cost. Overcharging Medicare for services that are not medically necessary, ordering durable medical equipment and supplies that are not medically necessary are only a few of the most typical types of Medicare fraud committed by healthcare professionals. If a patient’s existing diagnosis does not match up with additional laboratory and radiological services, the provider may bill Medicare for those services. As another example, suppose a physician bills Medicare for a wheelchair even though the patient is mobile, or suppose the patient orders a nebulizer equipment despite the fact that the patient has no medical history of respiratory problems. According to (Stowell et al., 2020), the financial impact of senior healthcare fraud impacts the patients, their families, the government, and taxpayers who pay extra to cover healthcare expenditures in public health plans as a result of the fraudulent activities.
References
The authors (Bauer, R. A., and Khoshgoftaar, T. M.) have published a paper in which they discuss their research (2020). A study on rare fraud predictions with big Medicare claims fraud data. Intelligent Data Analysis, 24(1), 141-161. https://doi.org/10.3233/IDA-184415
Congress.gov (2021). H.R. 4401-Protecting Seniors from Health Care Fraud Act of 2021. https://www.congress.gov/117/bills/hr4401/BILS-117hr4401ih.xml
Stowell, N. F., Pacini, C., Schmidt, M. K., & Wadlinger, N. (2020). Senior healt-hcare fraud under investigation. Journal of Financial Crime. https://doi.org/10.1108/JFC-04-2020-0071
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