tci Medicare Compliance & Reimbursement - 2019 Issue Q3

Compliance: Know the Difference Between Fraud and Abuse

Hint: ‘Gang visits’ aren’t what you think. If you’re thinking that all the Medicare rollbacks signal an easier road ahead, think again. Because federal enforcement activity indicates that fraudsters and abusers remain primary targets — and that’s why you need to know the essentials on Medicare fraud and abuse. What Constitutes Medicare Fraud? Though we often throw fraud and abuse into the same category, they are different. “Fraud occurs when someone intentionally falsifies information in an effort to deceive Medicare,” explains Gail O’Leary, consultant with Part B Medicare Administrative Contractor (MAC) NGS...

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