All Articles In 'Tag Archives: 'Program Integrity''
Health Care Fraud: Using Health Services Research to Detect Fraud and Abuse
Fraud in the health care system is a significant and growing threat. The FBI estimates that between 3% and 10% of all health care expenditures are lost to fraud each year – up to $280 billion [...]
Medicare Drug Benefit: Formulary Oversight in Medicare Part D
Medicare Part D, the Medicare drug benefit, served roughly 31 million seniors last year. Medicare Part D is more similar to Medicare Advantage than to traditional Medicare in that enrollees can choose among several private health [...]
Medicare and Medicaid Fraud: Breakdown of Types of Healthcare Provider Fraud and Abuse Cases
Fraud and abuse are common and persistent problems for Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). Combined federal and state spending now exceeds $1 trillion, with fraud and abuse likely costing taxpayers well over $100 billion [...]
Medicare and Medicaid Compliance: OIG Advice for Operating an Effective Compliance Program
Comprehensive compliance programs are essential for all hospitals, health systems, physician practices, Medicare Advantage plans, Medicaid health plans, Medicare prescription drug plans, drug manufacturers, medical device makers, long-term care providers, and others doing business with Medicare, Medicaid, or [...]
Medicaid Fraud and Abuse: Investigations, Prosecutions, Spending, and Staffing by State Medicaid Fraud Control Units in 2010
Nearly every State has a Medicaid Fraud Control Unit (MFCU) to investigate and prosecute cases of Medicaid fraud and patient abuse and neglect. MFCUs are a key part of an array of federal and state agencies combating [...]
Medicare and Medicaid Fraud: Voluntary Self-Disclosure of Potential Fraud by Hospitals, Physicians, and Other Providers
Medicare and Medicaid program integrity efforts – coupled with complex coding and claiming procedures, ever-increasing program requirements, new payment methods, and the growing market share of taxpayer-funded programs – present significant compliance challenges for health plans, hospitals, [...]
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