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Medicine and Health Sciences

Marshall University

Series

2017

Medicare fraud

Articles 1 - 2 of 2

Full-Text Articles in Business

Medicare Fraud, Waste And Abuse, Jamie Bush, Leslie Sandridge, Cierra Treadway, Kimberly Vance, Alberto Coustasse Dr. Ph, Md, Mba Mar 2017

Medicare Fraud, Waste And Abuse, Jamie Bush, Leslie Sandridge, Cierra Treadway, Kimberly Vance, Alberto Coustasse Dr. Ph, Md, Mba

Management Faculty Research

In 2014, the U.S. spent approximately $3 trillion on health care. Medicare accounted for $554 billion of these costs and around $60 billion were squandered due to incorrect billing methods, abuse, and fraud. Types of fraud included: kickbacks, up coding, and organized fraudulent crimes. To reduce the financial burden associated with these activities, the U.S. has created various fraud prevention programs. The purpose of this study was to identify methods of Medicare fraud, examine the various programs implemented by the U.S. government to combat fraud and abuse, and determine the effectiveness of these programs. While fraud prevention strategies have proven …


Medicare And The Affordable Care Act: Fraud Control Efforts And Results, Sarah Clemente, Ronald Mcgrady, Rob Repass, David P. Paul Iii, Alberto Coustasse Jan 2017

Medicare And The Affordable Care Act: Fraud Control Efforts And Results, Sarah Clemente, Ronald Mcgrady, Rob Repass, David P. Paul Iii, Alberto Coustasse

Management Faculty Research

Medicare fraud and abuse costs are estimated at 3%-10% of overall Medicare spending, which is expected to expand considerably until 2024 and as such the amount of fraud dollars would be expected to increase proportionally. The purpose of this research was to determine how recent reforms, especially the Patient Protection and Accountable Care Act, may affect Medicare fraud and abuse and to uncover the best strategies to combat Medicare fraud. The breadth of fraud and abuse within Medicare as well as recent reforms to fight fraud including legislative reforms, delivery system reforms, and other reforms including the formation of HEAT …