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. State Medicaid Program

    Health initiatives managed by state governments in conjunction ...
  2. Medicare Wages

    An employee's earnings that are subject to a U.S. payroll tax ...
  3. Securities Fraud

    A type of serious white-collar crime in which a person or company, ...
  4. Insurance Fraud

    An illegal act on the part of either the buyer or seller of an ...
  5. Phantom Stock Plan

    An employee benefit plan that gives selected employees (senior ...
  6. Medicare Supplementary Medical ...

    Health insurance sold by private insurance companies meant to ...
Related Articles
  1. Insurance

    Medicare Vs. Medicaid

    Medicare and Medicaid are often confused with one another, because they are both public health-care programs. This confusion likely arises from the similarities between the two programs. After ...
  2. Retirement

    How Medicaid Works After Retirement

    Reasons why, after you retire, you need to know how Medicaid works – and especially how it relates to Medicare.
  3. 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.
  4. 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.
  5. Financial Advisor

    Breaking Down Medicare Open Enrollment for Clients

    For financial advisors, open enrollment is an important opportunity to be of service to clients, especially when it comes to reviewing Medicare options.
  6. Insights

    What You Need To Know About Insurance Fraud

    Insurance fraud is as old as commerce. Discover the types of life insurance fraud and how they affect you.
  7. 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.
  8. Insurance

    Medicaid vs. CHIP: Understanding the Differences

    Medicaid and CHIP are both designed to provide low-income children with health care coverage. Find out about the differences between the two programs.
  9. Retirement

    Top 5 Strategies To Pay For Elder Care

    The cost of a nursing home, assisted living facility or home care can be ruinous. Try these routes to help seniors qualify for Medicaid and pay the bills.
  10. Financial Advisor

    Long-Term Care: How Medicaid Stacks Up

    Clients who think Medicaid is a good option for long-term care usually don't know the rules that come with the process of applying for it.
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. 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 >>
  3. 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 >>
Hot Definitions
  1. Market Capitalization

    The total dollar market value of all of a company's outstanding shares. Market capitalization is calculated by multiplying ...
  2. Frexit

    Frexit – short for "French exit" – is a French spinoff of the term Brexit, which emerged when the United Kingdom voted to ...
  3. Stop-Limit Order

    An order placed with a broker that combines the features of stop order with those of a limit order. A stop-limit order will ...
  4. Down Round

    A round of financing where investors purchase stock from a company at a lower valuation than the valuation placed upon the ...
  5. Keynesian Economics

    An economic theory of total spending in the economy and its effects on output and inflation. Keynesian economics was developed ...
  6. Portfolio Investment

    A holding of an asset in a portfolio. A portfolio investment is made with the expectation of earning a return on it. This ...
Trading Center