Medicare and Medicaid Fraud

Introduction

Medicare and Medicaid fraud is a major issue that has attracted the attention of physicians, hospitals, patients, insurers, policy makers, government agencies, and academics. This entry defines health care fraud and health care abuse, describes the prevalence of health care fraud in the United States, discusses the common Medicare and Medicaid fraud victims and perpetrators, and reviews efforts to combat the problem. While Medicare and Medicaid fraud occurs throughout the health care system, fraud involving publicly funded federal health care programs has attracted the most attention because of its enormous cost. Expenditures for Medicare, the federal health care program for the aged, reached $431.5 billion in 2007; total outlays for Medicaid, the joint federal and state health care program for the poor, were $335.8 billion.

Discussion

Medicare and Medicaid Fraud

In the United States one of every eight dollars spent on Medicare goes into the black hole of fraud, according to figures reported by this entity. No benefit to anyone and affecting the pocket of every taxpayer the millions of Medicaid and Medicare scams are a problem that could be solved if every user of the system up all your alerts. There is no concise definition of Medicare and Medicaid fraud; it is a broad phrase encompassing a spectrum of activities in which money that is intended to pay for health care services is in some way diverted to private use. Fraud is a legal term that refers to actions taken with the intent to deceive, such as intentional misrepresentation of information that insurers and government programs rely on in making payment decisions. A physician who intentionally submits a bill for services that were never performed, for example, deceives the payer into making an improper payment. (Becker, Daniel and Mark, 2005)

The scams are more common in medical equipment such as wheelchairs, walking aides, special air mattresses, feeding tubes, which have nothing to do with the patient's condition, but are billed. In the case of Medicaid which is a different story and that everyone must be responsible to monitor their own history and the entire system. Medicaid does not send a statement of any testing done to the patient and people can ask them to send a report about what they have done that include lab tests, special tests, etc. In addition to this, it is important that people are dependent on what they are including in their accounts when they follow a treatment or ask a team. At least with Medicare patients should receive a bill, a statement in the mail that shows what has been paid and if they see something strange should call us immediately. People do not understand there are things for which Medicare pays only once in five years. In addition to this, health care abuse lacks this intent, and often involves taking advantage of ambiguity in payment rules to bill in ways that are not technically illegal, yet may violate the spirit of the law. A physician who performs two separate medical procedures and receives two ...