Medicare and Medicaid: Opportunities to Save Program Dollars by Reducing
Fraud and Abuse (Testimony, 03/22/95, GAO/T-HEHS-95-110).

Medicare and Medicaid are overwhelmed in their efforts to keep pace
with, much less stay ahead of, profiteers who are bent on cheating the
system.  Both health programs have weak fraud and abuse prevention
programs.  Specifically, the programs (1) have strong incentives for
providers to overprovide services, (2) suffer from weak fraud and abuse
controls to detect questionable billing practices, and (3) impose few
limits on those that may bill--companies using post office box numbers
have qualified to bill the program for virtually unlimited amounts.
Further, profiteers have little chance of being prosecuted or having to
repay fraudulently obtained money.  Many cases are settled without
conviction, penalties are light, and providers often remain in business.

--------------------------- Indexing Terms -----------------------------

 REPORTNUM:  T-HEHS-95-110
     TITLE:  Medicare and Medicaid: Opportunities to Save Program 
             Dollars by Reducing Fraud and Abuse
      DATE:  03/22/95
   SUBJECT:  Medicare programs
             Medicaid programs
             Fraud
             Program abuses
             Overpayments
             State-administered programs
             Internal controls
             Health care cost control
             Claims processing
IDENTIFIER:  HCFA Medicare Transaction System
             
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