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Corruption - Intentional abuse of power for private gain, that can be committed by anyone within any process or level of an organization.

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Financing of health care becomes an even greater problem, limiting availability of government programs.

Patients lose trust in the healthcare system due to lack of integrity.

Resources such as equipment, medications, supplies and trained personnel become scarce.

Patients are diagnosed with illnesses they may not have, prescribed medications they do not need, or have unnecessary procedures done all to financially benefit the person or persons committing the act of corruption.

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It is estimated that about 10% of the total health care expenditure or 105-350 billion is lost every year in the US due to fraud. (Intelligence & Intelligence, 2019)

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The WHO (World Health Organization), UNDP (United Nations Development Programme), and the Global Fund created the Alliance for Anti-Corruption Transparency, and Accountability in Health initiative.

This Alliance was created to identify challenges and find solutions to prevent corruption.

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With Covid-19 creating havoc across the world many people have used this opportunity to capitalize on relaxed policies by committing fraud in the Healthcare system, from phony test kits to logistical fraud.

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10. Notable Healthcare Fraud Scheme in the USA

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10. Notable Healthcare Fraud Scheme in the USA

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Feds Charge 243 People for Medicare Fraud

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Used to explain why an individual committed fraud.

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9. What to consider when designing your own preventative measures. 

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9. What to consider when designing your own preventative measures. 

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1. The steps of the process.

2. Who performs each step of the process.

3. How payments are received.

4. Checks and balances.

5. Documentation requirements.

6. Verifications, supervision and oversight policies.

7. Incentives.

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There are two ways to approach corruption, the risk-based approach and the compliance approach.

The compliance approach puts more trust into the system. It believes that if all of the regulations seem to be followed and all of the documents and signatures are present then no fraud must have occured.

The risk-based approach does the opposite. It understands that those documents as described above could very well be forged so it looks at which issues cause the greatest risks.

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7. FRA Method                 (Fraud Risk Assessment)

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7. FRA Method                 (Fraud Risk Assessment)

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Designs context-specific corruption prevention controls.

Recommended by internal control, audit and fraud examiner associations.

Founded on risk-based approach.

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Intelligence, E., & Intelligence, E. (2019, June 07). A Ripple Effect of Healthcare Fraud in the USA. Retrieved November 14, 2020, from https://www.eos-intelligence.com/perspectives/life-sciences/a-ripple-effect-of-healthcare-fraud-in-the-usa/

Wierzynska, A., Steingrüber, S., Oroxom, R., & Bauhoff, S. (2020). Recalibrating the anti-corruption, transparency, and accountability formula to advance public health. Global Health Action, 13 doi:http://dx.doi.org.ezproxy.fau.edu/10.1080/16549716.2019.1701327