The Government Accountability Office (GAO) has designated Medicare and Medicaid as high-risk programs, in part due to their susceptibility to improper payments -- estimated to be about $70 billion in fiscal year 2010. Improper payments have many causes, such as submissions of duplicate claims or fraud, waste, and abuse. As the administrator of these programs, the Centers for Medicare and Medicaid Services (CMS) is responsible for safeguarding them from loss. This book explores fraud detection and deterrence in Medicare and Medicaid, with a focus on fraud detection systems; screening providers and suppliers; and program integrity.
Preface; Fraud Detection Systems:: Centers for Medicare & Medicaid Services Needs to Ensure More Widespread Use; Background Memo for the Hearing on Medicare Contractors Efforts to Fight Fraud:: Moving Beyond Pay & Chase; Medicare:: Progress Made to Deter Fraud, but More Could Be Done. Statement of Kathleen M. King, Director, Health Care, Government Accountability Office; Statement of Ted Doolittle, Deputy Director, Center for Program Integrity, Department of Health & Human Services; Testimony of Robert A Vito, Regional Inspector General, U.S. Department of Health & Human Services.
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