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.

RELATED TERMS
  1. U.S. Centers for Medicare and Medicaid ...

    The federal agency that administers the nation’s major healthcare ...
  2. Unbundling

    The process of taking over a large company with several different ...
  3. Fraud

    Fraud, in a general sense, is an intentionally deceptive action ...
  4. Corporate Fraud

    Activities undertaken by an individual or company that are done ...
  5. Contractor Fraud

    Illegal business practices committed by firms hired to reform, ...
  6. Association Of Certified Fraud ...

    An organization that was created to combat fraud and deception ...
Related Articles
  1. Insurance

    What's The Difference Between Medicare And Medicaid?

    One program is for the poor; the other is for the elderly. Learn which is which.
  2. Managing Wealth

    Medicaid and Nursing Homes: A Quick Guide to the Rules

    Medicaid can cover the costs of a long-term healthcare facility, if you qualify. But that's a big if.
  3. Financial Advisor

    How Much Medicaid and Medicare Cost Americans

    Medicaid & Medicare cost Americans plenty out of their paychecks. But how much, really? And what does that money buy?
  4. Insurance

    Medicaid Vs. Long-Term Care Insurance

    These are not equal. Here's why you need to think twice before relying on the government-sponsored program.
  5. Retirement

    Medicare Costs to Rise for Most in 2017

    Most senior citizens will see their Medicare expenses rise in 2017.
  6. Retirement

    Medicare Open Enrollment Ends Dec. 7

    Avoid these 4 mistakes during the Medicare Open Enrollment period (Oct. 15 to Dec. 7).
  7. Insurance

    Should Retirees Worry About Medicare Under Trump?

    With the Affordable Care Act on the chopping block, there are rumbles that Medicare could be next.
  8. Managing Wealth

    It's Open Enrollment: Move to Medicare Advantage?

    Oct. 15 - Dec. 7 is the time (after joining) to switch from Medicare's flexibility to the often broader coverage or lower cost of Medicare Advantage.
  9. Managing Wealth

    How to Choose the Best Medicare Advantage Plan

    Medicare Advantage offers an alternative to Medicare and Medigap. Here’s what you need to know to choose the best plan.
  10. Insurance

    What is Insurance Fraud?

    Fraud exists in every type of insurance, although the stakes tend to be highest with life insurance.
RELATED FAQS
  1. How does the role of Medicare/Medicaid affect the drugs sector in the U.S.? (UNH, ...

    Read about the impact of Medicare and Medicaid on the drugs sector in the United States and how some doctors get rich by ... Read Answer >>
  2. What effect has the sustainable growth rate had on Medicare disbursements?

    Read about the impact of the Medicare sustainable growth rate mechanism on rising Medicare costs and physician reimbursements ... Read Answer >>
  3. Does Medicare provide assistance for patients unable to perform Activities of Daily ...

    Find out how Medicare provides some benefits, both direct and indirect, for those who are unable to perform some of the activities ... Read Answer >>
Hot Definitions
  1. Call Option

    An agreement that gives an investor the right (but not the obligation) to buy a stock, bond, commodity, or other instrument ...
  2. Pro-Rata

    Used to describe a proportionate allocation. A method of assigning an amount to a fraction, according to its share of the ...
  3. Private Placement

    The sale of securities to a relatively small number of select investors as a way of raising capital.
  4. AAA

    The highest possible rating assigned to the bonds of an issuer by credit rating agencies. An issuer that is rated AAA has ...
  5. Backward Integration

    A form of vertical integration that involves the purchase of suppliers. Companies will pursue backward integration when it ...
  6. Pari-passu

    A Latin phrase meaning "equal footing" that describes situations where two or more assets, securities, creditors or obligations ...
Trading Center