Medicaid and Medicare Fraud
Describe health news story combating health care fraud Medicare Medicaid• Examine evaluate corporate structure governance, culture, focus social responsibility • Recommends
Medicare and Medicaid fraud: An overview
Medicare and Medicaid fraud: An overview
While there is still little consensus regarding the best ways to go about enacting healthcare reform, one issue that unites both Democrats and Republicans is the need to eliminate Medicaid and Medicare waste, fraud and abuse. According to a 2009 CBS News report: "One tiny pharmacy in a Hialeah [Florida] strip mall went from billing Medicare $13,000 in May to billing nearly a million dollars a month later," and regulators took no notice (Rosen & Bach 2009:1). It has been estimated by the Federal Bureau of Investigation (FBI) the fraudulent billings to public and private health care programs are 3 -- 10% of total health spending, $75 -- $250 billion per year on average, and that is only the fraud that is currently known (Morris 2009: 1351). Although federal authorities have tried to grow more vigilant, health care fraud is becoming increasingly difficult to detect. Approximately $60 billion of the total costs of healthcare fraud have been linked to Medicaid and Medicare, at direct cost to taxpayers (Taitsman 2011). "Since 1990, the Government Accountability Office (GAO) has designated Medicare as a high-risk federal program because its vast size and complexity make it vulnerable to fraud, waste, and abuse" (Iglehart 2010).
This fraud is perpetrated not only by unscrupulous patients and criminals, but also by physicians. One manufacturer of a prostate-cancer drug, for example, told urologists that they could bill Medicare for the free samples "though federal law prohibits physicians both from billing for free samples…Several urologists ended up paying tens of thousands of dollars in penalties for participating in the manufacturer's plan" (Taitsman 2011). Undeterred by fines, professional sanctions, or even civil or criminal legal system, physicians every year are found guilty of "accepting kickbacks, upcoding...
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