Integrity and Wrongdoing

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Healthcare fraud

Unfortunately, health-care fraud is a massive issue in many countries worldwide. In the United States, in 2012, over $2 trillion dollars was spent on health care, and about 10% of this amount corresponded to fraudulent expenses and inspections to investigate it (The Economist 2014). In Brazil, the scenario is similar: it is estimated that only in 2015, 22,5 billion reais, which represents 19% of the healthcare budget, was spent unduly. In fact, studies have shown that, in Brazil, over 10% of the actual expenses are unnecessary – around 40% of the exams done, for example, are expendable (Agencia Brasil 2017).

The Health Care Anti-Fraud Association (2016) lists a number of ways that healthcare fraud might happen: the unfair billing of services that were never provided or billing for more services that were actually handed; performing unnecessary medical assistance; diagnosis falsification to justify exams; billing procedures more than once; billing procedures more than they actually cost. In Brazil, fraud in the healthcare context happens mostly in terms of unnecessary procedures, exams and prescription of medications; excessive referrals; and poor assistance (Agencia Brasil 2017). A common practice in many hospitals, for example, is professionals of health (such as physiotherapists, dieticians, and physicians), to evaluate patients on their medical record when they weren’t even visited by these professionals.

As future physiotherapists, we must understand the gravity of having a fraudulent conduct. We must keep in mind not only the legal consequences of doing so but also to acknowledge the harm that we might cause to our patients and their relatives. Remembering always of the virtues and principles of bioethics will help us to do a good job and never contribute to fraud in the healthcare context.

References:

NHCAA (2016). The Challenge of Health Care Fraud. Retrieved on 5th June 2017, from <https://www.nhcaa.org/resources/health-care-anti-fraud-resources/the-challenge-of-health-care-fraud.aspx&gt;

THE ECONOMIST (2014). The $272 billion swindle. Retrieved on 5th June 2017, from <http://www.economist.com/news/united-states/21603078-why-thieves-love-americas-health-care-system-272-billion-swindle&gt;

AGENCIA BRASIL (2017). Fraudes e desperdícios consomem R$ 22,5 bilhões de despesas da saúde suplementar. Retrieved on 5th June 2017, from <http://agenciabrasil.ebc.com.br/geral/noticia/2017-03/fraudes-e-desperdicios-consomem-r-225-bilhoes-de-despesas-da-saude-suplementar&gt;

Post by Danielle Aquino. 

 

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