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 ?
Hilton denied Defendants' Motion to Dismiss finding that the government's complaint alleging Medicare fraud in the provision of skilled therapy services stated a viable cause of action under the False Claims Act.
A nationwide investigation by the federal Medicare Fraud Strike Force has led to health fraud charges against 243 people--including 46 medical providers --in the largest bust in strike force history.
Medicare fraud and strategies to combat the crimes have become more intense as the program has grown in size and complexity, experts say.
But the rise in the often duplicative audits has failed to reduce Medicare fraud, according to a report released Wednesday.
Attorney's Office filed a civil forfeiture lawsuit in an effort to seize Johnson's ex-wife's Mountain Home mansion, which prosecutors say was paid for with money from the Medicare fraud.
Office of Public Affairs The case was investigated by the FBI, HHS-OIG, Texas MFCU, RRB-OIG and OPM-OIG and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division's Fraud Section and the U.
Medicare fraud and abuse is undermining the health of seniors and costing taxpayers an estimated $60 billion to $90 billion every year.
Protecting Against Identity Theft and Medicare Fraud - 10 a.
Medicare Fraud Strike Force Indicts 28 in Texas: "In what one federal official described as 'one of the largest Medicare fraud takedowns in Department of Justice history,' the Medicare Fraud Strike Force indicted 91 people in seven cities on Thursday, including 28 in Dallas and Houston.
Department of Justice has charged 91 doctors, nurses, and other health professionals with Medicare fraud amounting to $295 million in false billing in eight cities.
Thanks to a larger-than-average senior population, which provides a larger-than-average potential pool of Medicare dollars from which to steal, the region is widely considered the epicenter of Medicare fraud.
1 million Medicare fraud scheme, the Departments of Justice and Health and Human Services (HHS) said.

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