PUP 4931r Lecture 30: pup lec 30
5 Apr 2018
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Submitting claims with false diagnoses to justify tests, surgeries or other procedures that are not medically necessary. **fraud involves knowing disregard of the truth; typically occurs when billing claims or cost reports are intentionally falsified. Fraud involves knowing disregard of the truth; typically occurs when billing claims or costs reports are intentionally falsified. Fraud is a major problem in medicare and medicaid. Examples: providing services not medically necessary or billing for a higher-priced service. The national health care anti-fraud association estimates conservatively that at least 3 percent of health care spending is lost to fraud. Studies show that over 30 billion dollars a year is lost to health care fraud in the united states. 1st time in more than 30 yrs the gov"t discloses how much is paid to individual doctors treating medicare patients. Recalcitrant provider- someone who is abusing the program and not changing inappropriate behavior even after intensive education to address behaviors.
