Medicare Fraud & Abuse

Background

Most Medicare payment errors are simple mistakes and are not the result of physicians, providers, or suppliers trying to take advantage of the Medicare system. The vast majority of therapists who serve people with Medicare are committed to providing high quality care to their patients and to billing the program only for the payments they have earned.

However, there are a few individuals who are intent on abusing or defrauding Medicare, cheating the program (and in some cases the people with Medicare who are liable for co-payments) out of millions of dollars annually. Medicare fraud takes a lot of money every year from the Medicare program. People with Medicare pay for it with higher premiums.

Medicare is taking strong action to combat fraud and abuse of the system in key areas. It is their goal to make sure Medicare only does business with physicians, providers, and suppliers who will provide people with Medicare with high quality services. (Source  www.medicare.gov)

HIPAA & BBA - Release of Significant Fraud & Abuse Parameters

Significant fraud provisions were included in HIPAA (Health Insurance Portability & Accountability Act) in 1996 and the BBA (Balanced Budget Act) in 1997.

 

 

quick links

10-6-2008: CMS Announces New Recovery Audit Contractors (RACs)

10-4-2008: OIG Releases New Rehab Fraud Case.

10-1-2008:  OIG Issues 2009 Work Plan:  Private practice therapy is identified.