Medicare fraud


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Medicare fraud

A generic term for any unlawful act which results in the inappropriate billing of Medicare for services by a healthcare provider, including physicians, hospitals and affiliated providers.
 
Examples
Billing for or performance of duplicated services, claims for services not rendered, billing for services not deemed medically necessary, miscoding of medical and/or surgical procedures, excess charges for services or supplies, breech of assignment agreements, billing Medicare patients at a higher or different fee schedule, waivers of co-payments and deductibles, and other improper billing practices.

Medicare fraud

Medifraud Medical practice Any unlawful act which results in the inappropriate billing of Medicare for services by a health care provider–eg, physicians, hospitals and affiliated providers. See Medicare.
References in periodicals archive ?
A new sophisticated Medicare fraud detection program incorporating advanced fraud risk and data analytics capabilities is already yielding strong results.
"The same spoon that serves indictments on drug dealers, felons in possession of firearms and corrupt officials will also feed those companies and individuals who engage in Medicare fraud," U.S.
The Medicare Fraud Strike Force, created in 2007, has charged nearly 4,000 people related to billings of more than $14 billion in total, DOJ said.
Officials said the scam was detected last summer as complaints from beneficiaries poured in to the Medicare fraud hotline.
Complaints from beneficiaries were pouring in to the Medicare fraud hotline, and some consumer news organizations warned seniors.
This case was investigated by the FBI with support from HHS-OIG and DCIS and was brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division's Fraud Section and the U.S.
There are two broad categories of legal jeopardy that hospices face: Medicare fraud and malpractice lawsuits.
Thousands of health care providers' NPIs are stolen each year and are used for further fraudulent schemes, including Medicaid and Medicare fraud. NPIs are vulnerable because they are not confidential and are publicly available on the National Plan and Provider Enumeration System.
The "best" include leaders and groundbreakers in psychiatry, oncology and health economics, whereas the "worst" includes those who faced criminal charges from murder to Medicare fraud.
Defendants were charged in more than 20 states, including California, Florida, Illinois, Louisiana, Michigan, and Texas, where the federal government operates Medicare Fraud Strike Forces.
Defendants were charged in more than 20 states, including Florida, Michigan, Texas, California, Illinois, and Louisiana, where the federal government operates Medicare Fraud Strike Forces.
Related: Medicare fraud affects home care for seniors

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