1. What is a health care crime in relation to economic crime?

Enumerate
four (4) types of healthcare crime. Explain how each is committed.

In connection to economic crimes, healthcare crime refers to illegal activities that

occur inside the healthcare industry and entail fraud, deception, or other illicit
behaviors for financial benefit.

(1) Healthcare Fraud - This entails knowingly providing false or misleading

information in order to get illegitimate benefits or payments from healthcare
programs such as insurance companies, government healthcare programs (e.g.,
Medicare or Medicaid), or private payers. charging for services that were not
performed, upcoding (charging for a more expensive service than was actually
provided), and delivering needless medical treatments are some examples.

(2) Prescription Drug Fraud – this encompasses unlawful prescription drug

manufacturing, distribution, or dispensing. Forging or modifying prescriptions,
engaging in prescription drug diversion, or running pill mills, where doctors prescribe
large amounts of banned medications for non-medical reasons, are all examples of
this.

(3) Kickbacks and Illegal Referral Arrangements – this comprise providing, receiving,
or soliciting cash or other inducements in exchange for patient or healthcare service
recommendations. These arrangements hinder fair competition and may result in
unneeded treatments or services.

(4) Counterfeit Pharmaceuticals – this involves the manufacture, distribution, or sale

of counterfeit or subpar medications. These counterfeit pharmaceuticals may be
deficient in active ingredients, labeled incorrectly, or contaminated, posing
substantial concerns to patient safety and public health.