...Insurance Fraud The term "insurance fraud" covers a wide array of activities that have the same basic purpose: to obtain payment from an insurance company by deceptive or dishonest means. While incidence of fraud is estimated to be low, it remains an area of great concern for insurers. Losses Due To Fraud As with most crimes, it is impossible to accurately gauge losses to fraud because only that which is detected is measurable, and the typical suggestion is that the "true" value may be significantly greater than the measurable value. With that in mind, it is (gu)estimated that 10% of insurance payments are attributable to fraud - which is again an entirely arbitrary number - and the cost of losses are ultimately borne by the consumers who pay insurance premiums. I have thus far found no source that expresses the actual (detected) fraud as a percentage of insurance claims. Tort vs. Crime vs. Moral Imperative Insurance fraud is clearly a civil offense: it is a misrepresentation that seeks to exploit a contract between private parties. However, because payments made on fraudulent claims raise the premiums paid by all insured individuals, insurance fraud is often treated as a criminal offense as well. The crime of insurance fraud is defined and prosecuted on the state level. There is only one clause in federal law that addresses the topic of fraud, but this pertains exclusively to federal healthcare benefits programs. Insurance fraud is classified as a criminal...
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...Health Insurance Fraud By: WAHEED ALKHAMEES KHALED ALNAFEE Further Issues Hospital Administration PA 551 Master of Health and Hospital Administration (Parallel) King Saud University One:- Introduction Definition Insurance is the equitable transfer of the risk of a loss, from one entity to another in exchange for payment. It is a form of risk management primarily used to hedge against the risk of a contingent, uncertain loss. An insurer, or insurance carrier, is a company selling the insurance; the insured, or policyholder, is the person or entity buying the insurance policy. The amount of money to be charged for a certain amount of insurance coverage is called the premium. Risk management, the practice of appraising and controlling risk, has evolved as a discrete field of study and practice. The transaction involves the insured assuming a guaranteed and known relatively small loss in the form of payment to the insurer in exchange for the insurer's promise to compensate (indemnify) the insured in the case of a financial (personal) loss. The insured receives a contract, called the insurance policy, which details the conditions and circumstances under which the insured will be financially compensated. Types of Insurance Services Insurance can take a number of different forms. Some of these types: Auto insurance Auto insurance protects the policyholder against financial loss in the event of an incident involving a vehicle they own, such as...
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...cost of health care continues to rise. In addition to the spiraling costs of the health care system, millions of Americans still could not afford any form of health care insurance. The question is what can be done about it? The answer is neither easy nor clear cut. In 2010, the Patient Protection and Affordable Care Act (PPACA) of 2010—commonly called the Affordable Care Act (ACA) or Obamacare, after its major backer, US president Barack Obama—sought to reform a number of aspects of the US health insurance industry, as well as improve the access to and quality of health care services. Keywords Americans with Disabilities Act; Best Practice Protocols; Fee for Service System; Grassroots Activism; Gross Domestic Product; Industrial Democracy; Managed Care; Medicaid; Medicare; Single-payer System; The Pepper Commission; The Rehabilitation Act - Bill 504 Health Care Reform in the U.S. Overview Health care is very much on the minds of Americans. Former presidential candidate Hillary Rodham Clinton made health care her platform and insisted that universal health care is achievable. Although affordable health care for everyone sounds like a positive step forward, the American public was not sure enough of that statement to support her election as president. The American health care system is bound to the insurance industry and has always been a fee for service system. To add to the dilemma, universal health care does not have universal support of the American people or the medical...
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...Reducing Workers Compensation Claims According to an essay published online by CCH Incorporated, the first step in reducing workers’ compensation costs involves ensuring that your company has effective safety and accident prevention programs in place to reduce the amount and severity of workplace illnesses and injuries. In addition to those programs, there are policies and procedures that should be implemented to help supervisors and Human Resources professionals in handling workers’ compensation claims in the most expedient manner possible. Having an active safety program has a number of benefits. Some are obvious. Others are not. A safety program gives employees a sense that their employer cares about them. Issuing personal protective equipment should be part of the safety program as should periodic inspection and replacement of worn or damaged safety equipment. Rotating work schedules or job duties can reduce repetitive-stress injury problems. An additional benefit is that doing so keeps workers more interested in their work and more focused on the job they are doing which also tends to reduce injuries. A mandatory safety training program also lets your employees know that any work related injury is bad for them and bad for the company. All employees should participate in safety activities including those workers in administrative positions or performing office work. Ideally, the message employers want to deliver is that everyone has a vested interest in minimizing these...
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...Thesis Statement The Health Care Reform is a complex issue and is a hot topic nationwide that has the government, health care facilities and providers, insurance companies, health care employees and Americans talking about the law with its advantages and disadvantage affecting the delivery of health care. Health Care Utilization Paper (Option A) The Patient Protection and Affordable Care Act was signed into law by President Barack Obama on March 23, 2010, along with the Health Care and Education Reconciliation Act of 2010 signed on March 30th. The Act is a product of the health care reform efforts of the Democratic 111th Congress and the Obama administration (Wikipedia, Health Care Reform,2013), putting in place comprehensive reforms that improve access to affordable health coverage for everyone and protect consumers from abusive insurance company practices. The law allows all Americans to make health insurance choices that work for them while guaranteeing access to care for the most vulnerable, and provides new ways to bring down costs and improve quality of care (The White House, 2013), to take effect and be completed in 2014. According to the website www.healthcare.gov, the Health Reform is already making a difference by increasing access to affordable care, making care more affordable, strengthen Medicare, holding insurance companies accountable, and laying the foundation for 2014. Increasing Access to Affordable Care (Millions of Americans have gained new access to more...
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...Unfortunately, the workers’ compensation system is subject to fraud by both employers and employees. On the employer side, some companies try to avoid the cost of paying workers’ compensation premiums by simply breaking the law and not insuring their employees. An audit in Florida, for example, found that 13 percent of employers did not have workers’ compensation insurance. Because premiums are based on payroll, some employers underreport their payroll.9 Employee fraud also occurs and can involve collecting benefits for exaggerated or nonexistent injuries. Fraudulent claims by employees can also include real injuries that were not work-related or stretching out recovery time so that disability payments continue for longer than is really warranted.10 To keep workers’ compensation rates under control, companies are becoming more aware of fraud and many are contesting claims they believe to be fraudulent (see the Manager’s Notebook, “Make Sure Workers’ Comp Claims Are on the Up-and-Up”). Some states have law enforcement units that focus on helping to combat workers’ compensation fraud, but they operate with limited staff and budget.11 CHAPTER 16 • MANAGING WORKPLACE SAFETY AND HEALTH 513 In another attempt to control and reduce workers’ compensation costs, some employers are using on-site occupational health centers that provide immediate evaluation and treatment of injured workers. These on-site centers offer faster treatment of occupational injuries and can...
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...is hired to do work of accounts payable. After sometimes clerk is hired on permanent full-time employee. There is a large or huge cash expenditure was revealed by the manager accounts payable within a few months (Donaldson, P. W, 2004).” In information system beside that the employees are performing well in accounts payable department which is the very sensitive department of hospital as it directly interact with the vendors and suppliers, two full time employees were terminated which increases the burden and department fails to cope with it because of which they have to hire a new employee on a temporary basis. As according to hospital rules temporary employees are not entitled for health insurance, vacation pay, disability insurance, etc. this thing force Matt Harris to do fraud as he is ill and have to cover medical expenses (Baskerville, R. 1. (1993). It’s the organizational procedure that every employ that is hired for sensitive departments like finance and IT, have to undergo through background...
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...Michelle Robinson 5/29/16 HCA255 Orazie Slayton Social Security Administration During the Great Depression of the early 1930s a form of Social Security was created but the federal government was not involved in the support of elderly people and their families, those concerns were considered to be handled locally or by the state. According to the America’s Historical Documents (n.d.), that changed on August 15, 1935 when president Roosevelt signed the Social Security Act, this act established a system of old –age benefits for workers, benefits for victims of industrial accidents, unemployment insurance, aid for dependent mothers and children, the blind, and the physically handicapped (America’s Historical Documents, n.d.). Now the Social Security Administration (SSA) operates as an independent federal agency under the Social Security Act. The framework, issues, and priorities of the Social Security Administration has an impact on health care policy and delivery. Like any other federal agency the Social Security Administration has a purpose and a mission that acts as a blueprint in how to meet the needs of the serviced population. The SSA serves a purpose to the public to provide protection for aged and disabled persons against the expenses of being ill, providing material needs of individuals and families, also keeping families together, and to give children the chance at a healthy and secure future. According to the Social Security Administration website (2016) their...
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...care, its citizens are left unattended. Other nations in the world have made health care as a basic right while the US consider it as a privilege and only accessible to those who can afford it. With this insight, everyone sees health care in the US as a commodity and not as a social service. Pohl writes that the uninsured Americans now number in tens of millions where most of them are those who are working hard to make ends meet (Pohl, 2002). Even with their employment (blue collar jobs, mostly), they still cannot access insurance because their employers do not provide them because of the high cost or these individuals are not eligible at all. Medicare/Medicaid. One of the biggest differences is Medicaid is a state governed program and Medicare is a federal governed program. Medicaid is applied for at your local Department of Health and Welfare’s Self Reliance office while Medicare is applied for at your local Social Security office. While Medicare is an insurance program where a member pays a monthly premium, Medicaid is a social service program that is managed by the State of Washington and is...
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...Ryan Mariotti October 21st, 2013 Professor Dana Benbow Centenary College Marvel Ltd. is a large insurance company that is interactive with employees by providing them with coverage. The coverage’s that they usually sell are insurance contracts, health insurance, life insurance, and disability benefits. Marvel mainly provides these benefits with a contract that is purchased by the employer of major corporations. Marvel agrees to provide the employee with these benefits as long as they pay back with a premium payment once a month. The amount is usually determined by the historical accounting of the cost of benefits by Marvel. Marvel uses data in the employer’s program to determine a projection of the expected cost for each of the benefits that the employer decides to purchase. Marvel will also add its expenses and profit margins where it will arrive at a premium that they agree on to provide the same benefits in the future for the employer. After the analysis is done, Marvel will make a projection as to how much it will cost and for how long the contract will last. The way that this contract is finalized is by a signature by the employer and the payment of the first month’s premium. Marvel and Billy Bob’s Famous Restaurants agreed on a contract very similar to the description above. They entered this contract through an agreement. Marvel agreed to give Billy Bob’s Famous Restaurants benefits and analysis’ in the future. Billy Bob’s Famous Restaurants agreed to this contract...
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...are the components and how are they financed? What are the problems facing Medicare? What are your solutions? Medicare: Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant). Administered by the US government since 1966, Medicare is currently using 30 private insurance companies across United States. In 2010, Medicare provided health insurance to 48 million Americans—40 million people age 65 and older and 8 million younger people with disabilities. On average, Medicare covers about half (48 %) of the health care charges for those enrolled in Medicare. The enrollees must then cover the remaining approved charges either with supplemental insurance or with another form of out-of-pocket coverage. Components of Medicare: Medicare has four parts. These different parts help cover specific services. Medicare PART A (Hospital/Hospice Insurance): Part A covers inpatient hospital stays including semiprivate room, food, tests, care in a skilled nursing facility, and hospice care. (Hospice care focuses on palliation of seriously ill patient's pain and symptoms, and attending to their emotional and spiritual needs) Medicare PART B (Medical Insurance): Part B medical insurance covers certain doctors' services, outpatient care, medical supplies, preventive services and products not covered by Part A. Part B is optional and may...
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...WELLPOINT About WellPoint WellPoint works to simplify the connection between Health, Care and Value. We help to improve the health of our communities, deliver better care to members, and provide greater value to our customers and shareholders. WellPoint is the nation’s largest health benefits company, with more than 33 million members in its affiliated health plans. As an independent licensee of the Blue Cross and Blue Shield Association, WellPoint serves members as the Blue Cross licensee for California; the Blue Cross and Blue Shield licensee for Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri (excluding 30 counties in the Kansas City area), Nevada, New Hampshire, New York (as the Blue Cross Blue Shield licensee in 10 New York City metropolitan and surrounding counties and as the Blue Cross or Blue Cross Blue Shield licensee in selected upstate counties only), Ohio, Virginia (excluding the Northern Virginia suburbs of Washington, D.C.), and Wisconsin. In a majority of these service areas, WellPoint does business as Anthem Blue Cross, Anthem Blue Cross Blue Shield or Empire Blue Cross Blue Shield (in the New York service areas). WellPoint also serves customers throughout the country as UniCare. www.wellpoint.com Mission, Vision & Values What Makes Us WellPoint With an unyielding commitment to meeting the needs of our diverse customers, we are guided by the following principles: Our Mission WellPoint's mission is to improve the lives...
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...Calculator (c) Order Transcripts (d) Commencement (e) Office of Dispute Management (f) University of Phoenix iGrad (g) Letter Center (h) Course Waiver Request (i) University Disability Services (j) SASWeb- Doctoral Dissertation (k) Request FERPA Release (l) Life Resource Center (m) Health Insurance Election Form (1) Credit Assessment Services (i) Prior Learning Assessment Center (a) Who is eligible to submit to Prior Learning Assessment? (b) Options covering eligible students i) Two ways to earn Prior Learning Assessment credits (a) Professional Training Portfolio (b)Experiential Learning Essays ii) How do I begin the submission process (a) Submission walkthrough iii) National Testing Programs (a) College Level Examination Program (CLEP) (b)Defense Activities for Non-Traditional Education Support (DANTES) (c)Excelsior College Examinations iv) Berlitz Language Programs v) College and Corporate Transfer Credits 1) Course Waiver Request vi) Undergraduate Level Course Waiver Request Form vii) Graduate Level Course Waiver Request Form 3) University Disability Services i) Student Disability Handbook ii) Campus Disability Services Advisor (Puerto Rico) iii) Campus Disability Services Advisor iv) Disability Services Management Team v) Director of...
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...Health Care Reform Project Part 1 David Chambliss HCS/440 - Economics January 12, 2016 Professor Kamal Faour Health Care Reform Project Part 1 The Price of Progress: Drugs In The Health Care Market This is a review of the above fore mentioned article. The U.S. health care system in the new century comes with good and bad news both stemming from the same source; medical innovation. The good news: life expectancy and health status in the United States are improving; infant mortality is declining and disability rates among the elderly have been falling. These improvements all point to one source: major pharmaceutical breakthroughs in the 1990s. The bad news: This medical progress is expensive meaning better medicine increases cost in the long run. Debate over our specific choices seems always to devolve back to a list of competing alternatives: restrict patient access; shift costs to the recipients of progress; shift risk to providers; or share through higher premiums the cost increases. . Unnecessary Regulations That Increase Prescription Drug Cost This is a review of the above fore mentioned article. As drug coverage has become more widespread, so too have calls to impose additional regulations on drug plans and the firms managing them. A reason sometimes given for increasing drug plan regulation is the need for transparency to prevent drug plan managers from excessive mark-ups for drugs at the expense of patients and health plans. In the...
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...com/blogs Insurance Digest for LIC AAO 2016 Exam Dear readers, This Insurance Digest is complete Information of important terms and plan & Policies and history. The Insurance Digest is important and relevant for all Insurance exams like - LIC AAO 2016 Exam, NICL, NIACL, Insurance and other Insurance Exams. What is Insurance? - Insurance is defined as a contract between two parties whereby one party called insurer undertakes in exchange for a fixed sum called premium to pay the other party called insured a fixed amount of money after happening of a certain event. According to the Indian Contract Act 1872, “A Contract may be defined as an agreement between two or more parties to do or to abstain from doing an act, with an intention to create a legally binding relationship.” Benefits of Insurance – It safeguards your money. It ensures growth of money. Life insurance policies are broadly categorized into 2 types – Traditional Plans and Unit Linked Insurance Plans (ULIPs). History-of-Life-Insurance-Corporation (LIC) - Life Insurance Corporation (India) (LIC) is an Indian state-owned insurance group and investment company headquartered in Mumbai. The Life Insurance Corporation of India was founded in 1956 when the Parliament of India passed the Life Insurance of India Act that nationalized the private insurance industry in India. Over 245 insurance companies and provident societies were merged to create the state owned Life Insurance Corporation. The Life Insurance Companies...
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