Healthcare Answer 2022

Running head: HEALTHCARE
HEALTHCARE
Name of the Student
Name of University
Author’s note

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HEALTHCARE
Answer: 1
Inappropriate payments by third party payers or insurance organizations occur due to
errors, fraud and abuse. The severity of this problem is vast and thus is an issue of priority in
healthcare system. Abuses deal with practices of the providers that either indirectly or directly
results in the generation of unwanted costs to the payer. Abuse includes any form of practice that
is not related with the main aim of providing the patients with healthcare services that are
medically important, fairly priced and meet the required professional medical standards (Centers
for Medicare and Medicaid Services, 2014). Insufficiencies or healthcare fraud is defined as
intentional deception that is used to enjoy unauthorized benefits. These are criminal offenses
under law but lack global consensus (Joudaki et al., 2015).
In order to prevent fraud and inefficiencies in the third party payments proper mining of
the emerging data is extremely important. The electronic health records and the growing use of
the computerized systems have added on to the new inspiring technology of the using soft copy
based data mining (information technology based approach). This is cost-effective and less time
consuming procedure that helps the third party insurance payers to easily detect the fraudulent
cases and inefficiencies. It also helps in the identification of the smaller subset of claimants for
further scrutiny in abuse or fraud cases (Joudaki et al., 2015).
Answer 2
As the healthcare reform generates incentives for proper alignment with the industry
competitors, organizations across the continuum of healthcare will experience their bottom lines
tied to partnership of success. A critical step of generating any form of partnership dealing with

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HEALTHCARE
different types of healthcare institution is to develop guiding framework for flow of funds with
the partners. Flow of fund is used in reference to remuneration to reflect the overall agreed-upon
sum within any particular transaction. This agreed upon sum exists between different partnership
like community hospital and medical center, incentive payments shared among hospital and
physicians and partnership with community-based non-profit organization and population health
management body (Evans & Stoddart, 2017). The fund flow framework mainly helps to govern
the flow of cash under different arrangements like purchased services agreement, discrete joint
operating agreements, joint investment and cost sharing, shared margins for new services and
virtual joint venture (Evans & Stoddart, 2017).
Cost of healthcare is US is higher in comparison to other countries. In United States, the
healthcare technology is advanced but it is expensive. Here the healthcare costs amounts to $3.3
trillion during the year 2016. With the growth of economy, the total amount of money spent in
healthcare is has also increased. During the year 2016, US spent approximately $9900 per person
for healthcare service and it higher than Switzerland by 25% (Milani & Lavie, 2015). In order to
manage the cost of healthcare in US, proper flow of fund is important. In US healthcare the flow
of funds occurs with the private sector insurance, government funded insurance and individuals’
personal payments. Under government funded insurance, patient protection and affordable care
act (ACC) holds prime importance. Other government insurance programs in the US healthcare
include Medicare and Medicaid. Medicare funds for healthcare requirement of the elderly,
disabled people or people suffering from long-term medical complications. Medicaid funds for
healthcare services availed by people who resides below the poverty level (Milani & Lavie,
2015).