Medicare And Medicaid Fraud

Definition of 'Medicare And Medicaid Fraud'


Illegal practices aimed at getting unfairly high payouts from government-funded healthcare programs. There are many types of Medicare and Medicaid fraud, including billing for services that weren't provided (phantom billing, upcoding), performing unnecessary tests or giving unnecessary referrals (pingponging), charging separately for services that are usually charged at a package rate (unbundling) and many more.

Investopedia explains 'Medicare And Medicaid Fraud'


Medicare and Medicaid fraud are a multi-billion dollar drain on a system that is already expensive to maintain. There are external auditors who are responsible for reviewing suspicious claim patterns, but the sheer volume means that many frauds can go undetected for years.



comments powered by Disqus
Hot Definitions
  1. National Best Bid and Offer - NBBO

    A term applying to the SEC requirement that brokers must guarantee customers the best available ask price when they buy securities and the best available bid price when they sell securities.
  2. Maintenance Margin

    The minimum amount of equity that must be maintained in a margin account. In the context of the NYSE and FINRA, after an investor has bought securities on margin, the minimum required level of margin is 25% of the total market value of the securities in the margin account.
  3. Leased Bank Guarantee

    A bank guarantee that is leased to a third party for a specific fee. The issuing bank will conduct due diligence on the creditworthiness of the customer looking to secure a bank guarantee, then lease a guarantee to that customer for a set amount of money and over a set period of time, typically less than two years.
  4. Degree Of Financial Leverage - DFL

    A ratio that measures the sensitivity of a company’s earnings per share (EPS) to fluctuations in its operating income, as a result of changes in its capital structure. Degree of Financial Leverage (DFL) measures the percentage change in EPS for a unit change in earnings before interest and taxes (EBIT).
  5. Jeff Bezos

    Self-made billionaire Jeff Bezos is famous for founding online retail giant Amazon.com.
  6. Re-fracking

    Re-fracking is the practice of returning to older wells that had been fracked in the recent past to capitalize on newer, more effective extraction technology. Re-fracking can be effective on especially tight oil deposits – where the shale products low yields – to extend their productivity.
Trading Center