Medicare Fraud and Quality Care, Essay Example

Introduction

In trying to make healthcare affordable, mandatory, and available to citizens in the United States, healthcare has become an issue with the insurance industry, business sector, and healthcare organizations. With over 90 million in the United States that are covered under Medicaid and Medicare, the healthcare industry is vigorously subject to continual reforms on healthcare to improve on quality care, and fraud prevention. The priority of giving quality care to every single American by the following 20 years is the establishment of Medicaid and Medicare educates, subsequently underlines the imperativeness of medicinal services measures. The course of action that is recommended in not only increasing quality care, but also prevent fraud is implement new standards in which are a requirement for health services that look for Medicaid and Medicare for reimbursements.

Background

The state of healthcare in the United States has experienced substantial changes that have left millions without adequate insurance for healthcare. “Original Medicare isn’t designed to achieve outcomes beyond paying beneficiaries’ claims and guarding against fraud and abuse in the program.” (Humana, 2013) Apart of the Social Security Act signed into Congress in 1965, Medicare is a qualification program that was made with a particular end goal to give healthcare insurance to individuals that are beyond 65 years old or who are incapacitated in any limit paying little heed to their level of salary. Medicare is fundamental in giving protection to the developing number of seniors who are left without protection, social insurance bills, and no cash to pay for care. The present problems, however, the increasing expense to healthcare, and the increasing number of individuals who enlisting help. Fraud, mismanagement, and quality care issues are widespread and is costing Americans billions in taxes. (Matthews, 2013) Medicaid is an entitlement program that provides healthcare coverage for families, individuals, elderly, children, and those with disabilities. They cover a number of pertinent services which includes; physician, ambulance, clinic, prenatal, and other healthcare services.

Stakeholder Analysis

The issue of health insurance is long being up for debate, and bone of contention for tax-payers and individuals with no insurance. Every American citizen is a stakeholder in this situation, as both programs are federally funded, and supported by taxpayers. Medicare is a health insurance program that serves more than 48 million enrollees, however the system costs over $549 billion. (Gov, 2014) Medicaid currently serves more than 55 million Americans, and increasingly growing, as Healthcare insurance becomes mandatory. Over 100 million people currently enrolled in the program have a stake in the future of the program, as they depend on its coverage and services to maintain adequate healthcare. The public in which pays taxes, also has stake, as they are federally funded, and when it is defraud costs the government, and ultimately the citizens. By improving services and making changes, more people will be able to be covered, as well as the public will be ensured that the enrollees will be taken care of.

Cost/Benefit Analysis

The costs of continuing both social programs, with both having a major problem with fraud, and quality care, as the program is becoming a burden on the states, costing upwards of $60 billion. (Senate, 2012) If the costs of fraud and inadequate care continue, it could cost upwards of $121 billion by 2050. (Senate, 2012) The benefits, however, ensure that millions of children, families, and low-income individuals are able to receive the healthcare services that they need, which includes physical and prenatal services. The benefits also ensure that the elderly which are quickly forgotten have adequate services that their cost of living, and other healthcare issues.

Summary

The proposal is that Medicaid and Medicare programs be reformed in order to improve on their quality care and fraud prevention. Both problems not only create a problem for taxpayers, burdens states with billions, but also creates complications for the millions of people that the programs cover. The decision is to implement an accountability program in which creates standards in which healthcare organizations that rely on reimbursements from the program be continuously monitored reevaluated, and continually retraining staff in the procedures and correct guidelines. The following recommendations is to form a committee or separate agencies that can monitor, assess the problems, and forms solutions to the increasing problems with not only the state of healthcare, but also the federally funded programs.

References

How is Medicare Funded? (2013). Medicare.Gov. Retrieved from http://www.medicare.gov/about-us/how-medicare-is-funded/medicare-funding.html

Matthews, Merril. (2012). Medicare and Medicaid Fraud Is Costing Taxpayers Billions. Forbes. Retrieved from http://www.forbes.com/sites/merrillmatthews/2012/05/31/medicare-and-medicaid-fraud-is-costing-taxpayers-billions/

Medicare – Humana Government Relations. (2013). Humana.  Retrieved from https://www.humana.com/about/public-policy/humana-on-the-issues/medicare

Medicaid and Medicare – Tom Coburn. (N.d.). Senate. Gov. Retrieved from http://www.coburn.senate.gov/public/index.cfm?a=Files.Serve&File_id=4d81849a-33f