Funding For Medical And Health Related Services

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The Medicaid is the program that provide funding for medical and health-related services to people of low-income families who either have no medical insurance or have inadequate medical insurance. Medicaid eligible recipients include children, the elderly and patients with disability. It is funded by a combination of both state and federal governments. Total healthcare spending in America is about $2.7 trillion annually on healthcare, or 17% of GDP and with the reform initiatives under Affordable Care Act, the number of people covered for insurance and the amount spent will grow dramatically and it is also estimated that fraud added as much as $98 billion to Medicaid and Medicare spending annually. No evidence was available to say…show more content…
In 2007, Government Accountability Office (GAO), reported that there is inappropriate increase in Federal Medicaid spending and determined that Medicaid program likely to be at high risk for abuse and fraud. (Centers for Medicare and Medicaid Services, 2011)
Fraud and Abuse in Medicaid According to Centers for Medicaid and Medicare Services, Medicaid fraud is said to be “knowingly or willingly misrepresenting the truth to defraud and obtain money or property of healthcare benefit program” while abuse happens “when doctors or health care providers perform activities that directly or indirectly result in unnecessary healthcare costs in healthcare program”. Many state that if regulation is made on unnecessary services, then there will be reduction in the cost of spending on the Medicaid. The most common types of fraud and abuse that occur in Medicaid are billing for services not performed, double billing, substitution of generic drugs, unnecessary services, up coding, kickbacks, unbundling, cost reports and identity theft or use of provider numbers. All these frauds and abuses increases strain on Medicaid Trust Fund. According to Medicare Fraud Control Units (MFCU) for the fiscal year 2013, annual reports on number of cases registered for fraud and abuse are shown in the below figure.
Figure 1: Percentage of cases filed for the FY 2013 Source: OIG analysis of Quarterly Statistical Report, 2013.
The figure above represents
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