Fraud & Abuse – Medicare and Medicaid fraud, waste, and abuse affect every American by draining critical resources from our health care system, and contribute to the rising cost of health care for all. Taxpayer dollars lost to fraud, waste, and abuse harm multiple parties, particularly some of our most vulnerable citizens.
Fraud occurs when someone intentionally executes or attempts to execute a scheme to obtain money or property of any health care benefit program. The primary difference between fraud and abuse is intention.
Abuse occurs when health care providers or suppliers perform actions that directly or indirectly result in unnecessary costs to any health care benefit program. While some fraud schemes may involve legitimate care, some fraud schemes never involve real care, such as false storefronts pretending to operate a business.
Each working day, Medicare processes over 4.6 million claims, of which 200,000 are for durable medical equipment, from a total of 1.5 million fee-for-service providers.
Each year, Medicaid processes 3.9 billion claims, representing more than $430 billion paid annually, for more than 57 million beneficiaries.
Further reading –
https://www.cms.gov/Outreach-and-Education/Look-Up-Topics/Fraud-and-Abuse/Fraud-page.html