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Guide to Controlling Fraud


As part of the United States establishing our uniquely-American best health care for all system, we individual Americans need to know how to make certain that our health care for all system maintained as the best system.

One way to have the best health care for all and keep it is to prevent, avoid and minimize the amount of fraud that occurs.

The following guide is being developed related to controlling fraud. This guide's first version was documented in November 2011. The guide will be developed and refined over time.


The Basics

Understand your health care, including doing your homework

You should expect good communications and explanations from your health care professional(s). You should feel comfortable about being a partner in your health care decision-making with your health care professional(s). If you have any questions or simply do not understand what is occurring, ask for an explanation(s).
Most health care professionals are good people who want to partner with you regarding your health and health care. Give them chances to communicate and educate. If and when they give you recommended reading, you need to read that information as part of your responsibility as being a good patient. They are busy people who must rely on you to do your "homework" as part of your role as a patient.

Minimum actions to take when suspicious: communicate

If you suspect that some person(s) within a medical professional's office is doing something that might be fraudulent, do the following:

1. Take careful notes of what activity(ies) occurred or what is occurring.

2. Communicate your concerns in writing to the medical professional in writing. Alternatively, immediately speak with the medical professional to get an explanation of why the activity is occurring or what question you have about it. Take notes or get a brochure(s) or recommended reading.

3. Get a written response from the medical professional about your question(s) or concern(s). You may find within that written communication the medical profesisonal has explained to you why the activity is necessary or you may learn that the medical professional decided to stop doing the activity ... or do the activity in a more appropriate manner.

 


Question possible health care activity that might be unnecessary.

Confirm that a health care activity is necessary.

If you feel that a health care activity is clearly something that was not decided by you and your doctor, then question it.

Example. You or someone you know has a new-born baby or toddler. You and your child go to the doctor for a well-baby check-up to confirm the status of development. At the start of each visit you are weighed and your blood pressure is checked. If you know of no need for your medical status to be checked every time, question why that is occurring. You should only get that service if you and your doctor have jointly decided on that activity.

Result. (This is a win-win situation.) The possible outcomes include these:

  1. Your conversation with your doctor or other medical professional results in you becoming more educated.

    Note: Regarding the example of a "well-baby visit" you may learn that it is standard practice to also check the mother for specific measurements for a certain number of weeks after the child's birth.
  2. Your conversation concludes with the realization (by you and the medical professional) that a certain test or other activity is not required for your situation. That may save you time, effort and some inconvenience.
  3. If the health care activity was borderline or not (regarding fraud), any decision to NOT do a specific health care activity is a contribution to one or both of these items:  A) U.S. health care costs and B) availability of those health care resources to someone else who definitely needs the same health care activity for their health care.

 

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