Fraud in healthcare

Abstract

Fraud is intentional deceit to obtain an unjust advantage or injury to the rights or interests of another, which would lead to civil and/or criminal liability. Fraud in healthcare not only causes harm to patients but also to the society, as it carries a financial cost to the healthcare system. There are many types of frauds in healthcare, such as misrepresentation to patients to receive unnecessary medical treatments and/or not in their best interests, misrepresentation or forgery of medical claims, corruption in the delivery of services and procurement, and misuse of position to gain personal benefits. Fraud also includes improper consent or falsifying patients’ medical conditions to deceive third parties. Measures are needed to prevent frauds in healthcare since it is damaging both to the health of patients and society, as well as creating a national social burden. The enhancement of effectiveness, professionalism, and efficiency have little or no impact unless they are founded on the moral norms of healthcare ethics.