Medicare Healthcare Medical Billing Insurance Fraud Video

Legal Aspects of Healthcare
Student’s Name
Institutional AffiliationLegal Aspects of Healthcare
Healthcare fraud can be defined as a crime that encompasses misrepresentation of information, covering up information or deceiving people with the aim of making a financial gain. This type of crime can be committed by both individuals and healthcare providers in a number of ways (Department of Health and Human Services, 2016). Understandably, laws relating to healthcare fraud differ across different jurisdictions despite the fact that there are federal and state laws to hold accused persons responsible. A case example of healthcare fraud can be drawn from US ex rel. Bledsoe v. Community Health Systems where the defendant was accused of engaging in different types of frauds in an effort to increase amount of reimbursement from Medicaid and Medicare. This is a classic example of how the country is losing billions of dollars to healthcare fraud.
In the above case, the plaintiff alleged that the defendant (CHS) defrauded the government by up coding or miscoding items that were billed to Medicaid and Medicare a crime that amounted to fraudulent billing and falsified claims. Fraudulent billing is a crime under the 31 U.S.C. § 3729 (a) (3) (Deloitte, n.d). On its part, the up-coding of contract services represents contractual bleach in that it violated the settlement agreement between the defendant and the government. This case is also true for falsification of medical document through miscoding of patients’ diagnosis. This is also in violation of the False Claims Act which prohibits healthcare providers from providing fraudulent or false claims knowingly (Department of Health and Human Services, 2016). If found guilty, a healthcare provider is liable to pay civil penalties and costs the Relator incurred in bringing up the lawsuit.
Up-coding occurs when the health care provid...