Beyond the Bedside: How Healthcare Integrity Roles Combat Fraud, Waste and Abuse

Healthcare FWA

The term “healthcare” may seem straightforward in its meaning: the care for one’s health. It brings to mind images of clinicians and patients striving for wellness in a medical setting.

But it’s so much more than that. It’s the practice of medicine, of course: as well as the checks and balances, support systems, and research and innovation. Bedside patient care sits at the core, while behind-the-scenes clinical networks and infrastructure hold it together.

Healthcare Integrity is a key part of this infrastructure. It is the vital area charged with protecting patients, facilities, and government agencies from healthcare Fraud, Waste, and Abuse (FWA).

Positions in this field are a great transition for clinicians looking to leave the bedside but who want to remain in healthcare. Who better to fight FWA than those who know first-hand how the healthcare system works?

What is Healthcare FWA?

Healthcare Fraud, Waste, and Abuse (FWA) refers to both intentional acts and unintentional misappropriation of healthcare spending. Intentional or otherwise, all FWA is damaging. Billions of dollars each year are wasted due to FWA; not only impacting the healthcare industry at large but devastating the people harmed by these offenses.

Engaging in FWA is subject to administrative, civil, or criminal liability.

Fraud is the intentional action of deliberately misrepresenting healthcare services for financial gain. Waste and abuse refer to actions that, while possibly unintentional, result in improper payment or unnecessary costs to healthcare programs and patients.

Examples of fraud include:

  • Charging for services or supplies that are not provided
  • Billing for nonexistent prescriptions
  • Altering medical records to receive higher payment

Examples of waste include:

  • Excessive prescriptions or office visits
  • Ordering excessive tests
  • Prescribing more medications than necessary

Examples of abuse include:

  • Unknowingly misusing claim codes
  • Unknowingly billing for brand name drugs when generics are dispensed
  • Unknowingly billing for unnecessary services

Protecting from harm

At the bedside, clinicians abide by “do no harm” – focusing on the physical well-being and safety of their patients. But what about beyond the bedside?

Intentional or otherwise, harm comes in many forms beyond the physical: loss of trust, financial damage or ruin, and emotional trauma to name a few. At the heart of Healthcare Integrity is the protection of people: protecting them from the harm that results from FWA.

Be part of the solution

Healthcare Integrity clinicians work to detect, prevent and resolve FWA in healthcare billing. They hold practitioners accountable by shining a light on ways to improve systems, build a trusted and safe environment for people, and minimize or prevent human error – intentional or otherwise.

Healthcare warriors aren’t just at the bedside. When those 12-hour shifts feel like doubles; laundering stains from your scrubs and shoes is more of a chore than a badge of honor; or you find yourself wondering what could be next on the career ladder, consider a transition to a role in healthcare integrity. This work is always evolving, in-demand, and remains an invaluable support for the entire healthcare industry.

You can be part of the solution when it comes to protection from FWA in healthcare. We’re here to answer any questions you may have about how to transition from the bedside to one of these vital roles behind-the-scenes.

Contact Us to learn more!

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