Medicare Fraud

2905 Words Mar 17th, 2013 12 Pages
Medicare Fraud: The History, Incidence, Costs and Institutional Remedies
John H Everett
Wayland Baptist

Medicare Fraud: The History, Incidence, Costs and Institutional Remedies What is Medicare fraud? ("F&A," 2011, p. 1) states “Medicare fraud happens when Medicare is billed for services or supplies you never got. Medicare fraud costs Medicare a lot of money each year.” What is Medicare abuse? ("F&A," 2011, p. 1) defines this as “Abuse occurs when doctors or suppliers don’t follow good medical practices, resulting in unnecessary costs to Medicare, improper payment, or services that aren’t medically necessary.” In reviewing the definitions of fraud and abuse by Medicare it may be hard for some people to
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Some of the key types of Medicare fraud are as follows: Incorrect billing, phantom billing, false certification, inappropriate services, bribing patients, charging for equipment and supplies which are never supplied, double billing involves charging for more than once for the same service, code jamming and upcoding. One of the first big cases in Medicare fraud was with a company called National Medical Enterprises (NME) in 1994. The suit alleged patients rights were abused and NME settled for almost $600 million back in the middle 1990s. One of the conditions of the settlement agreement was NME had to sale of it specialty hospitals. NME later became to be known as Tenet Healthcare. In 2002, Tenet went through another fraud case with Medicare, this time they were charged with raising there charges by a large amount each year to reach Medicare outlier payments on a majority of its Medicare patients. This suit almost cost Tenet to go under as a business. Still today, Tenet is trying to recover almost nine years later from the effects of this case. The largest in Medicare fraud involved a company called Columbia/HCA, now it is known just as HCA. The net settlement

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