Final answer:
Fraud, waste, and abuse in healthcare include the pharmacy splitting prescriptions for additional fees, using someone else's insurance information for prescriptions, and falsifying medical records. These fraudulent activities affect health programs like Medicare, Medicaid, and the ACA, especially under the fee-for-service model.
Step-by-step explanation:
The issue of Fraud, Waste, and Abuse (FWA) in healthcare is a serious concern that can lead to increased costs and diminished quality of care. Examples of FWA include:
- The pharmacy splitting the original prescription to receive additional dispensing fees, which is an example of fraud as it involves deceptive practices to gain undue payment.
- Using another person's medical insurance information to obtain prescriptions, which is also fraud, as it involves intentional deception for personal gain.
- Falsifying signatures or medical records, which is fraud as well, because it involves the intentional alteration of records to misrepresent the care provided.
These practices can affect various health programs such as Medicare, Medicaid, and the Patient Protection and Affordable Care Act (ACA or Obamacare). Under the fee-for-service model, there is a particularly high risk of FWA, as providers are paid for each service rendered, tempting some to bill for services that were unnecessary or not even provided. The challenge of addressing these issues lies in balancing the costs of treatments, patient quality of life, and the risks to individual privacy.