Medicaid is a joint federal and state program that provides healthcare to low income families and individuals. Additionally, Medicaid may assist the elderly and disabled people with nursing home costs and long term care expenses. This care involves tremendous amounts of money. In fact, the federal government website (CMS.gov) states that Medicaid spending in 2022…
Medicare provides health insurance for people over 65 years old, certain younger people with disabilities, or people with end stage renal disease. Medicare is a federally funded program and all providers receiving payments from Medicare must follow federal and state regulations and laws. Sadly, there are billions of dollars lost each year due to fraudulent…
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…