Medicare And Medicaid Fraud

AAA

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.

RELATED TERMS
  1. Corporate Fraud

    Activities undertaken by an individual or company that are done ...
  2. Fake Claims

    The term fake claims refers to insurance claims that are made ...
  3. Medicare

    A U.S. federal health program that subsidizes people who meet ...
  4. Healthcare Sector

    A category of stocks relating to medical and healthcare goods ...
  5. Medicaid

    A joint federal and state program that helps low-income individuals ...
  6. Fullz

    A slang term that criminals who steal credit card information ...
Related Articles
  1. Home & Auto

    Fighting The High Costs Of Healthcare

    If your employer is cutting medical benefits, a health savings account may be right for you.
  2. Insurance

    Services That Health Insurers Often Decline

    Learning how to navigate health insurance pitfalls will make you a more educated healthcare consumer.
  3. Options & Futures

    What's The Difference Between Medicare And Medicaid?

    One program is for the poor; the other is for the elderly. Learn which is which.
  4. Insurance

    What Does Medicare Cover?

    Don't assume you're insured. Find out what you can expect from this healthcare program.
  5. Entrepreneurship

    Stop Scams In Their Tracks

    Find out how to protect yourself and your loved ones from financial fraudsters.
  6. Professionals

    Helping Clients Choose Long-Term Care Insurance

    The need for long-term care has become an inescapable (and pricey) issue for retirees. Here's what financial advisors can do to help.
  7. Stock Analysis

    Could Amgen's Next Drug Be Worth $100 Billion?

    Amgen hopes it will win an FDA green light for evolocumab, a next-generation cholesterol fighter, which could grab a big chunk of the global statin market
  8. Stock Analysis

    How IPG Photonics Is Tapping Into The Auto Boom

    The manufacturing process of big industrial companies involves sophisticated laser technology to ensure precision and optimal efficiency in production.
  9. Stock Analysis

    Could This Drug Make Isis Pharmaceuticals Soar?

    Warfarin has been doctors' go-to anticoagulant for decades, but recently launched next-generation anticoagulants are increasingly winning market share.
  10. Stock Analysis

    3 Things That Could Hold Intuitive Surgical Back

    Taking a long-term view that favors Intuitive Surgical developer increasing in value, doesn't mean that there are near-term headwinds facing this company.

You May Also Like

Hot Definitions
  1. Price-To-Sales Ratio - PSR

    A valuation ratio that compares a company’s stock price to its revenues. The price-to-sales ratio is an indicator of the ...
  2. Hurdle Rate

    The minimum rate of return on a project or investment required by a manager or investor. In order to compensate for risk, ...
  3. Market Value

    The price an asset would fetch in the marketplace. Market value is also commonly used to refer to the market capitalization ...
  4. Preference Shares

    Company stock with dividends that are paid to shareholders before common stock dividends are paid out. In the event of a ...
  5. Accrued Interest

    1. A term used to describe an accrual accounting method when interest that is either payable or receivable has been recognized, ...
  6. Absorption Costing

    A managerial accounting cost method of expensing all costs associated with manufacturing a particular product. Absorption ...
Trading Center