The Medicare and Medicaid Programs

OIG estimates that overpayments due to a cabal of billing errors, contrivance, medically unnecessary services, and other problems cost the American taxpayers some $12.6 billion in fiscal 1998. Under the protective cover of the Department of Justice ( justness) and the legal mechanisms of the False Claims Act (31U.S.C. sec3729(a) -3733), DOJ has undertaken numerous investigations of hospitals, other private sector health safekeeping providers, and physicians suspected of engaging in one or other of the practices which represent inappropriate use or claims for Medicare championship (Scanlon, 1999).

At issue in these investigations have been questions related to both Medicare fraud and sophisticate. The problem is of significance in that a substantial heap of America's older population and its handicapped citizens rely primarily or even exclusively on Medicare (and to a lesser degree, Medicaid) for funding their health care needs (Scanlon, 1999).

George Grob (1999), Deputy Inspector everyday of HHS's OIG, commented that Medicare provides health insurance for 39 million elderly and disabled Americans at an estimated annual cost of $217 billion for fiscal grade 1999. Contractors, specifically intermediaries who surgery claims under Part A and carriers who process claims under Part B of Medicare receive an estimated $1.8 billion individually year to carry out their essential clerical activities.

Unfortunately, says Grob (

Department of Health and Human Services. (1996). check up on of Chiropractic. Washington, D.C.: U.S. Government Printing Office.

review on problem areas much(prenominal) as durable medical

Abuse in nursing Homes, Nursing Facilities, and Hospices

Taylor, M. (2000). Sentencing soon in fraud case. Modern Healthcare, 30(40), 28-31.

Rovner, J. (1998). Medicare cracks down on mental health fraud. Lancet, 352(9135), 1206-1207.

1. Increasing the effectiveness of medical

Scanlon, W.J. (1999). Medicare fraud and abuse - DOJ's implementation of False Claims Act guidance in field initiatives varies. Report to Congressional Requesters, August 6, 1-13.

. Waiver of copayments or deductibles under

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