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Medical Negligence Claims Fraud

Medical Negligence Claims Fraud

October 6, 2016 12:05 am0 comments

Insurance fraud of any kind has by some people been identified as victimless crime as there is no victim, as such suffering the consequences, however this is untrue especially when fraud is combined together with the health and medical industry. Insurance fraud has took on a whole new perspective as in the past it was based around insurance companies being scammed whereas now people are actually being punished through such fraudulent schemes, not only are people’s insurance premiums dramatically increasing due to the fact of the amount of insurance claims being put through but innocent drivers are being put in the firing line as they are being blamed for accidents which was the others sides fault or people are setting up accidents so other people are at blame. Not only is this increasing disturbing and frightening but also very dangerous for car users.

Medical Negligence FraudFraud within the medical negligence claims area is rare but not as much as it was in the past however there still is not a lot of room for victims of medical negligence to create fraudulent claims nor is it clear whether patients can claim fraudulent medical negligence as much of the work done in medicine is highly documented and recorded for the sake of the patient as much as to keep efficient hospital records. It is entirely possible for victims of medical negligence to slightly exaggerate the consequences of the negligence but most that are involved in medical negligence suffer greatly anyway. It is possible for victims to state greater pain amounts or psychological injuries that never took place and are difficult to verify. If you believe that you have been a victim of medical negligence and you have a valid claim then you may be able to make a medical negligence compensation claim. The medical negligence process must not be taken lightly especially if the negligence suffered is quite severe and it is vital to always be prepared. Medical negligence is the omission or act of a health care worker that a service that has been provided is below the standard expected and as a result such a service has caused a victim to experience further ill health as a direct consequence.

In America fraud and the health care industry is not so rare as medical insurance is acquired for people to receive medical treatment, if people do not have the funds to have medical insurance then it is up to the Government to provide sufficient health care treatment and this leaves room for the health care provider to make fraudulent health care claims.

Health Care Industry and Fraudulent Activity

The National Audit Office has produced figures which show that patient fraud was costs the NHS around 112 million yearly and the figures are only estimated and it has been stated that another 81 million of the NHS funding was said to be at risk of such fraud. The estimated patient fraud is guaranteed to rise as it has not been taken into consideration the amount of fraud committed by contractors and NHS Trusts. The NHS Counter Fraud Service has estimated these figures after an investigation took place in to actions of fraud within the NHS.

Fraud and embezzlement within the NHS pose risks and consequences to patients. The Health Care and Social Act of 2012 was set to implement changes to how the NHS worked but did not adequately address the area of fraud correctly as it is vital so that fraudulent activity is to be policed correctly and new structures to combat such fraud to be implemented which critics have said has not happened. It has also been brought to attention that resources to address fraud functions have been decreased allowing such fraud within the NHS to take place. In turn this may have a huge effect on patient care and treatment as massive some of monies may be lost through fraudulent activity.

It has been made clear that through new government policies connected to the NHS that due to the suggestions and even increase of private medical firms to deliver NHS services there is very likely to be an increase in fraudulent activity. As more health services are being contracted out the government has been advised that fraudulent activity is likely to increase. The ‘principal-agent’ theory clearly states that any person or organisation contracted out is more than likely self-interested and only aimed to concentrate on their own business needs and gaining maximum profit.

Types of Medical Negligence and Fraud

Fraud can take place within the health industry within a number of ways these may include;

  • A health care worker stating that they have the correct qualifications and training for the job when in reality then are not trained to the standard they state.
  • A doctor from a foreign country may show the correct qualifications on paper but they may have been forged in some way so extra care and attention must be taken when reviewing paper work.
  • Fraud may take place within the cosmetic industry in as much as cosmetic providers stating they are medically trained to carry out work such as Botox and filler injections but in reality do not have any medical training.
  • Beauty salon and beauty spa may pose qualified personal but the staff do not have the training to accompany it.

More insight to medical negligence can be found at .gov and you can gain government insight in to medical negligence and the processes involved.