Ambulatory Payment Classification (APC) fraud refers to deceptive practices related to the billing and reimbursement system used primarily for outpatient services under Medicare. The APC system categorizes outpatient services into groups based on clinical similarity and the resources they require, with each group assigned a fixed payment rate. This system is designed to streamline billing…
What Is The False Claims Act in Healthcare The False Claims Act (FCA) is the most successful anti-fraud law in the United States. This federal statute was enacted to protect the public FISC by encouraging private citizens to expose fraud involving federally funded contracts or programs, such as Medicare and Medicaid. It’s important to note…
Medicare Integrity Program (MIP) contractors play a pivotal role in safeguarding the integrity of the Medicare program. Their core mission is to prevent, identify, and combat fraud, waste, and abuse within Medicare, ensuring that the program remains sustainable and trustworthy for its beneficiaries. These contractors are tasked with a range of activities including auditing Medicare…