Medicare and Medicaid
Table of Contents
Executive Summary 2
Summary Statement 2
I. Introduction 3
II. About Medicare 4
III. About Medicaid 5
III. Fraud & Abuse of Medicare 7
IV. Fraud & Abuse of Medicaid 8
V. Prevention Program Methods/Reform for Medicare & Medicaid 9
VI. Conclusion 12
References 13
Executive Summary
With the ever-changing difficulties of our health insurance landscape, the government has taken a more active role in the health care and well-being of American citizens. With this shift, programs like Medicare and Medicaid, become polarizing topics in an environment where individual finances are tight, our economy is struggling, and the future is no longer as predictable or financial secure as we once believed it to be. Medicare and Medicaid programs will be the focus of this analysis. The paper will explore the history behind these programs, some common fraud and abuse methods and techniques, and will finally discuss possible solutions and tactics in place to mitigate future manipulation of these programs.
Summary Statement
Fraud and Abuse of the Medicaid and Medicare programs in the United States is a widespread and pervasive problem. Institutions, health care providers and individual consumers all have a role in fraud and abuse prevention. It impacts everyone even if you do not currently benefit from one of these government programs.
I. Introduction
There is no doubt that the health insurance landscape of today’s society is drastically different than what our grandparents experienced decades ago. With health insurance reforms and the growth of a health insurance marketplace, the government hopes to ensure health coverage for more Americans than ever before. The health insurance paradigm has shifted from a privilege to a basic right, but it has not come without immense debate, discussions over the quality of care and its rising costs. The new reform proposed by the Obama administration to insure every American has sparked
Executive Summary 2
Summary Statement 2
I. Introduction 3
II. About Medicare 4
III. About Medicaid 5
III. Fraud & Abuse of Medicare 7
IV. Fraud & Abuse of Medicaid 8
V. Prevention Program Methods/Reform for Medicare & Medicaid 9
VI. Conclusion 12
References 13
Executive Summary
With the ever-changing difficulties of our health insurance landscape, the government has taken a more active role in the health care and well-being of American citizens. With this shift, programs like Medicare and Medicaid, become polarizing topics in an environment where individual finances are tight, our economy is struggling, and the future is no longer as predictable or financial secure as we once believed it to be. Medicare and Medicaid programs will be the focus of this analysis. The paper will explore the history behind these programs, some common fraud and abuse methods and techniques, and will finally discuss possible solutions and tactics in place to mitigate future manipulation of these programs.
Summary Statement
Fraud and Abuse of the Medicaid and Medicare programs in the United States is a widespread and pervasive problem. Institutions, health care providers and individual consumers all have a role in fraud and abuse prevention. It impacts everyone even if you do not currently benefit from one of these government programs.
I. Introduction
There is no doubt that the health insurance landscape of today’s society is drastically different than what our grandparents experienced decades ago. With health insurance reforms and the growth of a health insurance marketplace, the government hopes to ensure health coverage for more Americans than ever before. The health insurance paradigm has shifted from a privilege to a basic right, but it has not come without immense debate, discussions over the quality of care and its rising costs. The new reform proposed by the Obama administration to insure every American has sparked
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