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.
BREAKING DOWN '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.