Fraud and Abuse: Medicare Continues to Be Vulnerable to Exploitation by
Unscrupulous Providers (Testimony, 11/02/95, GAO/T-HEHS-96-7).

GAO discussed challenges Medicare faces in battling fraud and abuse in
the health care system, focusing on reasons that: (1) Medicare is an
appealing target for unscrupulous providers; and (2) abusive practices
persist despite efforts by program managers and law enforcement
agencies. GAO noted that: (1) although most Medicare providers abide by
program rules, Medicare has difficulty preventing fraudulent and abusive
practices; (2) some unscrupulous providers such as home health agencies,
pharmacists, and medical suppliers are attracted by high reimbursement
rates for some supplies and services and the few barriers to entry into
the Medicare marketplace; (3) exploitative providers often escape
detection because of inadequate claims oversight, insufficient
resources, and fragmented authority responsibilities; and (4) those
providers convicted of fraud face minimal sanctions.

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

 REPORTNUM:  T-HEHS-96-7
     TITLE:  Fraud and Abuse: Medicare Continues to Be Vulnerable to 
             Exploitation by Unscrupulous Providers
      DATE:  11/02/95
   SUBJECT:  Medicare programs
             Program abuses
             Fraud
             Medical expense claims
             Overpayments
             Medical services rates
             Health care cost control
             Billing procedures
             Claims processing
             Nursing homes
IDENTIFIER:  Medicaid Program
             CHAMPUS
             Civilian Health and Medical Program of the Uniformed 
             Services
             HCFA Medicare Transaction System
             HHS Operation Restore Trust
             California
             Florida
             New York
             Illinois
             Texas
             
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