scholarly journals The Private Healthcare Insurance sector: A victim of fraud

2021 ◽  
pp. 263380762110681
Author(s):  
Graham Brooks ◽  
Peter Stiernstedt
Keyword(s):  
Private Insurance ◽  
Insurance Fraud ◽  
Primary Research ◽  
The Public ◽  
Insurance Sector ◽  
Private Healthcare ◽  
Secure Data ◽  
Healthcare Insurance

Regardless of the jurisdiction research has repeatedly highlighted that the ‘public’ see the insurance sector as an acceptable business to defraud. This article builds on this work but is different in that we draw on primary research, of which there is little, into the private healthcare insurance sector as a victim of fraud. We start by highlighting the types and volumes of fraud that the insurance sector encounters. This is followed with an examination of policing private insurance fraud in a neo-liberal context where individuals and organisations are responsible for risks. Then, we consider if the private healthcare insurance sector is precipitating and participating in its own victimisation. The methods used in this research to secure data are then explained. Finally we analyse how the key elements of the data might point to the private healthcare insurance sector potentially precipitating and participating in its own victimisation.

Potential Financial Impact of First Assistant Billing by Surgical Residents

2007 ◽  
Vol 73 (7) ◽  
pp. 652-657 ◽  
Author(s):  
Atul K. Madan ◽  
Timothy C. Fabian ◽  
David S. Tichansky
Keyword(s):  
Healthcare System ◽  
General Surgery ◽  
Private Insurance ◽  
The United States ◽  
Insurance Companies ◽  
General Surgery Residency ◽  
Private Healthcare ◽  
Pro Bono ◽  
Healthcare Insurance ◽  
Case Logs

General surgery residency involves a mixture of 1) education of residents and 2) service by residents. The service that residents provide is not directly reimbursed in our current healthcare system by private healthcare insurance companies. This investigation characterizes the amount of reimbursement a typical resident would be able to collect if residents were allowed to collect for their services as a first assistant. The case logs of residents who graduated over 2 years from our general surgery residency program were reviewed. Data from each resident's last 2 years (postgraduate years 4 and 5) were included in this study. Relative value units (RVUs) for each Current Procedural Terminology code were reviewed. Collections were calculated by multiplying the Medicare conversion factor of $36.7856/RVU, the corresponding RVU, and a “standard” collection rate of 16 per cent for first assistants. There were 13 general surgery residents. These residents provided first assistant help with 91,473 RVUs over 2 years. A total amount of $535,380 could have been collected on first assistant fees for the last 2 years of their residency. Each resident would have been able to collect an average at least $41,414 just for first assistant operative fees. Resident assistance in the operating room provides significant savings for private healthcare insurance companies each year by reducing the need for first assistants. The data demonstrate that private insurance companies receive a considerable amount of pro bono service from residents. Changes in the financing of the current healthcare system in the United States will require educators to examine other sources ( i.e., private insurance companies) for support of graduate medication education.

Social versus Private Insurance

2018 ◽  
Author(s):  
Pierre Pestieau ◽  
Mathieu Lefebvre
Keyword(s):  
Social Insurance ◽  
Private Insurance ◽  
Population Ageing ◽  
Fiscal Competition ◽  
Public Insurance ◽  
The Public ◽  
Social Risks ◽  
The Family ◽  
Private And Public

This chapter looks at the role of the public versus the private sector in the provision of insurance against social risks. After having discussed the evolution of the role of the family as support in the first place, the specificity of social insurance is emphasized in opposition to private insurance. Figures show the extent of spending on both private and public insurance and the chapter presents economic reasons to why the latter is more developed than the former. Issues related to moral hazard and adverse selection are addressed. The chapter also discusses somewhat more general arguments supporting social insurance such as population ageing, unemployment, fiscal competition and social dumping.

scholarly journals How healthcare structures and communication delivery influence trust: a parallel-group randomized controlled trial

2021 ◽  
Author(s):  
Stephen Cantarutti ◽  
Emmanuel M. Pothos
Keyword(s):  
Controlled Trial ◽  
Random Order ◽  
Healthcare Sector ◽  
Public Healthcare ◽  
The Public ◽  
Private Healthcare ◽  
Public Healthcare Sector ◽  
Parallel Group ◽  
Therapy Compliance ◽  
Study Offer

Abstract Background According to recent polling, public trust in the healthcare sector remains low relative to other industries globally. The implications of low healthcare trust permeate throughout the industry in a number of ways, most visibly by discouraging therapy compliance. Methods This study investigated four putative determinants of trust in healthcare-related scenarios: individuals vs. collective groups as communicators of healthcare advice; expert vs. laypeople as providers of healthcare communication; public vs. private healthcare sector; and positive vs. negative information. Two hundred seventy-four participants were recruited via Prolific Academic and were presented with four statements in random order, related to a positive reflection of the public healthcare sector, a negative reflection of the public healthcare sector, a positive reflection of the private healthcare sector and a negative reflection of the private healthcare sector. According to these reflection, participants were repeatedly asked to rate the system on its trustworthiness. Trust outcomes were constructed using a four-dimension framework, consisting of benevolence, reliability, competence and predictability. Results Claims relating to the public sector had a significantly stronger impact on benevolence and reliability than claims relating to the private sector; claims from individuals had a significantly stronger impact on all trust variables than claims from collectives; and claims from laypeople had a significantly greater impact on reliability and competence ratings than claims from experts. Conclusions The findings in this study offer insight into the patterns with which trust decisions are made in healthcare contexts. More importantly, this research offers a novel perspective of how different factors interact to affect the various facets of trust. These results provide a foundation for future study in this evolving area, and offer insights into designing effective communication strategies that cultivate greater levels of individual trust in the healthcare sector.

scholarly journals Public and private sectors collective response to combat COVID-19 in Malaysia

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Ching Siang Tan ◽  
Saim Lokman ◽  
Yao Rao ◽  
Szu Hua Kok ◽  
Long Chiau Ming
Keyword(s):  
Insurance Coverage ◽  
Healthcare Providers ◽  
Screening Tests ◽  
Public Healthcare ◽  
Private Hospitals ◽  
Public And Private ◽  
The Public ◽  
Private Healthcare ◽  
Care Services ◽  
Challenges And Opportunities

AbstractOver the last year, the dangerous severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread rapidly around the world. Malaysia has not been excluded from this COVID-19 pandemic. The resurgence of COVID-19 cases has overwhelmed the public healthcare system and overloaded the healthcare resources. Ministry of Health (MOH) Malaysia has adopted an Emergency Ordinance (EO) to instruct private hospitals to receive both COVID-19 and non-COVID-19 patients to reduce the strain on public facilities. The treatment of COVID-19 patients at private hospitals could help to boost the bed and critical care occupancy. However, with the absence of insurance coverage because COVID-19 is categorised as pandemic-related diseases, there are some challenges and opportunities posed by the treatment fees management. Another major issue in the collaboration between public and private hospitals is the willingness of private medical consultants to participate in the management of COVID-19 patients, because medical consultants in private hospitals in Malaysia are not hospital employees, but what are termed “private contractors” who provide patient care services to the hospitals. Other collaborative measures with private healthcare providers, e.g. tele-conferencing by private medical clinics to monitor COVID-19 patients and the rollout of national vaccination programme. The public and private healthcare partnership must be enhanced, and continue to find effective ways to collaborate further to combat the pandemic. The MOH, private healthcare sectors and insurance providers need to have a synergistic COVID-19 treatment plans to ensure public as well as insurance policy holders have equal opportunities for COVID-19 screening tests, vaccinations and treatment.

The role of financial analysis using financial models to predict the financial stumble on the Saudi public utilities sector: An applied study: دور التحليل المالي باستخدام النماذج المالية للتنبؤ بالتعثر المالي على قطاع المرافق العامة السعودية: دراسة تطبيقية

2020 ◽  
Vol 4 (14) ◽  
Author(s):  
Najla Ibrahim Abdulrahman, Fatimah Ibrahim Alkhamis
Keyword(s):  
Capital Market ◽  
Analytical Approach ◽  
Financial Models ◽  
Financial Analysis ◽  
Public Utilities ◽  
The Public ◽  
Insurance Sector ◽  
Applied Study ◽  
The Right

This study aimed to find out the role of financial analysis using financial models to predict the financial stumble on the Saudi public utilities sector. The study was based on the financial analysis of the financial lists published by the sample of the study of the Gas and Manufacturing Company (Gasco) and the Saudi Electricity Company listed in the Saudi Capital Market Authority. During the period (2009-2018) I followed the descriptive analytical approach. The study found the effectiveness of the Abdul Rahman model to predict the financial stumble on the public utilities sector, and the low effectiveness of the Altman model and the Kida model to predict financial stumbles on the utility sector. The study also recommended encouraging audit offices to add financial analysis services to the possibility of predicting and addressing financial stumbles, directing companies using financial models that help predict financial stumbles, encouraging investors to use financial models that help predict financial stumbles to make the right decision, and directing researchers in the study of financial default forecasting on the insurance sector using the Abdul Rahman model.

scholarly journals Die Kulanz in der Schadensversicherung

2021 ◽  
Author(s):  
Jan Lucas Gutsche
Keyword(s):  
United Kingdom ◽  
Public Perception ◽  
Private Insurance ◽  
Economic Perspective ◽  
Future Change ◽  
Insurance Law ◽  
Legal Principles ◽  
The Public ◽  
The United Kingdom ◽  
Positive Light

Ex gratia is an integral part of the practice of private insurers. In the public perception, it is predominantly seen in a positive light. This work shows that ex gratia can neither always be reconciled with the legal principles of private insurance law, nor is it always unobjectionable from an economic perspective. The relevant German actors have so far remained inactive in this regard. A comprehensive legal comparison with the United Kingdom provides insightful guidance on how to enforce the legal conformity of ex gratia. The developments in the United Kingdom suggest that a future change in the approach in Germany is conceivable.

scholarly journals Insurance Fraud in Korea, Its Seriousness, and Policy Implications

2021 ◽  
Vol 9 ◽  
Author(s):  
Jeyong Jung ◽  
Byung-Jik Kim
Keyword(s):  
Big Data ◽  
Central Government ◽  
Policy Implications ◽  
Limited Attention ◽  
Insurance Fraud ◽  
The Public ◽  
Big Data Technologies ◽  
National Initiative ◽  
Active Interest ◽  
Dynamic Concentration

Several characteristics of insurance fraud including its chronic nature justifies the need for identifying feasible proposals which can be expected to bring about significant impacts. Recent statistics show that insurance fraud is now consistently on the increase. However, insurance fraud is highly fragmented and each offence is not significant enough to elicit active interest among the public or interventions from the police. Three problems have been identified and diagnosed. These were a lack of awareness, an absence of a national leadership and also limited attention directed to insurance fraud by the investigating authorities. Based on these, three recommendations have been suggested. (1) Embarking on and developing a national initiative by central government, (2) Taking a dynamic concentration approach to send deterrent threats to potential fraudsters, and (3) Using big data technologies to detect clandestine activities by organised groups.

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