IntroductionThe health sector in Australia loses millions of dollars through fraudulent means every year. The large amounts of money that are swindled to the pockets of people hurt the insurance industry by forcing people to set high premiums. A majority of these cases result from the illegitimate allocation of funds by the boards of Medicare through the issue of deceptive information across the insured persons, the hospitals, and the state (Joudaki et al., 2015, p. 194). Examples of such cases are charging for health problems not present, falsifying documents, financial alteration to a calculated advantage, and placing claims on extra services without informing members of the health fund. It is essential to investigate increasing cases of the financial crime in the health sector to promote efficiency and effective service delivery in the industry.
Literature Review
Changing Regulatory Environment
Estimates issued to the ABC prove that the Federal Government is currently receiving more than a thousand top-offs across various observers of the growing fraudulent cases in the Australian healthcare sector. This follows a statement to the audit commissioners to charge a co-payment of six dollars to every doctor visitation plan within the country. Among 240 cases, 30 already suggest fraud which means that the malice, is more significant than previously deemed by the government (Tomar and Agarwal, 2013, p.243).
The cases are currently in the hands of Public Prosecutions under the Commonwealth department, 12 of which are already in a conviction against proof of fraud. Beliefs suggest that most of the fraud matters happen outside the premises of the hospital where persons involved; most doctors try to conceal the profits from the public eye (Tsingou, 2010, p. 622). A review done in 2013 shows that at least nineteen doctors were subject to refunding a more than a million dollars to the health department within 2012 to the 2013 year of service making almost 20 million dollars in that year (Tomar and Agarwal, 2013, p.250).
The Human Services department is fed up with this habit especially with its consistent growth and, therefore, made a statement that it will deploy at least 3 of its officers to each hospital with the aim to mitigate the crisis. The step follows cries from the stakeholders both private and public members of hospitals that the cost of getting medication keeps getting stringent even with the massive amounts paid to health insurers annually. Reports also propose that the worst cases in health care fraud appear when unlawful doctors collaborate with the insurance agents in the region.
Impacts of Health Care Fraud
The healthcare finances in Australia are standard according to the budget allowance on an annual basis. Financial crime in the sector eventually causes a hiccup to the smooth flow in the economy since funds directed towards ensuring ongoing medical care in the nation get misdirected to other purposes instead. Survey data from the Safety Survey shows that the number of funds and personnel required to do a comprehensive survey for the financial crime in the sector are critically high to the state since it needs clinical attention on each aspect in healthcare to determine the flaws (Tomar & Agarwal, 2013, p. 257)
For every crime, there is a formation of a multiplier to state the actual loss in value, which is the approximate number of crimes to the ratio of the missing funds, and further consideration of the hospitals with more likelihood of embezzling more funds. Medical costs needed a review of all cases whether injured or sick and treated of those failed to receive treatment due to lack of adept funding, giving the surveyors a tough task in figuring out the level of mismanagement in the facilities and outside the doctors’ offices. Overall crime in Australia projects over 19 billion dollars, while fraud crimes make most of this figure. Additional charges on attaining pertaining matters of the same cases result in a total of 32 billion dollars.
Remedies to Financial Crime
The first resolution from the government, which comes hand in hand typically with the judicial system is locking away these fraudulent characters as an example to other people who plot to commit fraud with the aim of scaring them off. For instance, scholars agree that as much as doctors are more useful to the nation outside prisons, cases of fraud that contribute to the highest junk of spendable funds lost to specific people are not worth any degree of skill to the country (Webster-Wright, 2009, p. 724). Therefore, the government deploys as many bodies as possible to get rid of the problem.
The department of compliance and fraud commits auditors to perform, unannounced regular fraud to verify details and do so as well when any complain becomes known against payment issues and bottlenecks to receive medical care due to costs (Tomasic, 2011, p. 11). The Federal government also offers its services by funding investigations that come up in the sector against the health personnel, the nationwide program of medicine, and the benefits scheme in pharmaceuticals. It is indeed crucial that the fraudulent persons in the industry come to justice so that the costs of conducting medical care do not keep disappearing into thin air.
Continuing Professional Development (CPD)
The Continuing Professional Development (CPD) gives directives to every doctor in Australia to maintain their requirements and decorations as medical practitioners in the country as long as they still serve according to expectations (Tomasic, 2011, p. 17). CPD means that they need to renew their certifications of practice and need to register with the national health board on a regular basis to ensure that their presence in the economy is in check. Through allegedly following up with the documentation, it is easier for concerned parties such as the federal government and the compliance to keep in line with each development and information is readily available on the availability of these people (Webster-Wright, 2009, p. 729).
Financial crime in Australia is one of the cases that lead to degradation of the economic value of the nation. It also slows down development in the country due to unfavorable costs that would instead go to ethically deserving plans of the government.
- Joudaki, H., Rashidian, A., Minaei-Bidgoli, B., Mahmoodi, M., Geraili, B., Nasiri, M. and Arab, M., 2015. Using data mining to detect health care fraud and abuse: a review of literature. Global journal of health science, 7(1), p.194.
- Tomar, D. and Agarwal, S., 2013. A survey on Data Mining approaches for Healthcare. International Journal of Bio-Science and Bio-Technology, 5(5), pp.241-266.
- Tomasic, R., 2011. The financial crisis and the haphazard pursuit of financial crime. Journal of Financial Crime, 18(1), pp.7-31.
- Tsingou, E., 2010. Global financial governance and the developing anti-money laundering regime: what lessons for international political economy?. International Politics, 47(6), pp.617-637.
- Webster-Wright, A., 2009. Reframing professional development through understanding authentic professional learning. Review of educational research, 79(2), pp.702-739.
