Fraud and Abuse

A pair of unethical and potentially illegal acts that can get a physician or other health care provider into trouble:
• Fraud—the deliberate billing for a service that was never given or for a service that has a higher reimbursement than the service produced
• Abuse—payment for items or services that are billed by mistake by providers, but should not be paid for by Medicare
References in periodicals archive ?
29, 2014 /PRNewswire-USNewswire/ -- Pharmaceutical Care Management Association (PCMA) President and CEO Mark Merritt today outlined policy solutions that could reduce prescription fraud and abuse in Medicare Part D at a Capitol Hill briefing, " Prescription Opioid Abuse: Fighting Back on Many Fronts," sponsored by the Alliance for Health Reform and PCMA.
Since the inception of the program in 1997, the Health Care Fraud and Abuse Control (HCFAC) Program has returned more than $25.
The legal action is part of a series of measures launched by the company in 2011 to curb medical insurance fraud and abuse, shielding its 2.
Daman maintains zero tolerance for such violations and is taking every measure to limit the damage from fraud and abuse of health insurance.
In 2011, Daman introduced a rigorous auditing protocol and investigation procedures to detect fraud and abuse, including a trend analysis for any indication of potential abuse or fraud.
Physicians may find themselves under increased scrutiny as a result of provisions in the Affordable Care Act--one of the health reform laws--giving government agencies new funding and enforcement powers to go after fraud and abuse.
The Affordable Care Act--one of the health reform laws--gives government agencies new enforcement powers and new funding to go after fraud and abuse and physicians may find themselves under increased scrutiny as a result.
Produced by Baumann (Arrent Fox PLLC) under the auspices of the American Bar Association Health Law Section, this volume explores legal and regulatory issues relevant to health care fraud and abuse in the United States.
As a result, providers should expect significantly more federal government involvement and unprecedented coordination with state governments in detecting and investigating alleged Medicaid fraud and abuse activities.
Small businesses are the most vulnerable to occupational fraud and abuse and suffer disproportionately larger losses as a result, according to the 2004 "Report to the Nation on Occupational Fraud and Abuse" prepared by the Association of Certified Fraud Examiners.
With the projected increases in expenditures and the rising number of Medicare and Medicaid program participants, the United States Department of Justice (DOJ), the Office of the Inspector General of the United States Department of Health and Human Services (OIG) and state Medicaid Fraud Control Units (MFCU) continue to expend significant resources pursuing fraud and abuse.