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Essay / Research Paper Abstract
This 20 page paper provides an overview of the issues of Medicare fraud and the impacts. Bibliography lists 10 sources.
Page Count:
20 pages (~225 words per page)
File: MH11_MHFalse44.rtf
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Unformatted sample text from the term paper:
1980s, a focus on the issue of Medicare fraud has resulted in an increased application of legal doctrine devised to support the False Claims Act (FCA) in reducing Medicare billing
fraud. More specifically, the Balanced Budget Act of 1997 and the Health Insurance Portability and Accountability Act of 1998 were both developed to strengthen the FCA relative to the
issue of fraudulent Medicare billing (1). Even so, as much as 10 percent of all Medicare billing is intentionally fraudulent, and constant efforts by the government to recover lost
funds have resulted in costly legal pursuits (2). In fact, in 2003, the False Claims Act was applied in the recovery of over $2 billion, $1.48 billion of which
was the result of investigations following tips from whistleblowers (3). Though it is evident that legal directives are in place to address the issue of Medicare fraud, the question
that arises is whether or not the legal directives for appropriate participation in Medicare and their punitive elements are effective deterrents to the crime. If the law is clear,
applicable and valued, why, then, does fraud persist? The answer: Medicare fraud persists because the cost of successfully circumventing the system and securing fraudulent payments is more lucrative
then the financial "risk" of being caught. Like any crime, if the law is lax in either the presence of legal directive or its enforceability, criminal behavior will continue.
Background The False Claims Act (FCA), 31 U.S.C. ?? 3729-3733 was revised in 1986 with a focus on the issue of false claims made in medical billing, especially to
government agencies, including Medicare and Medicaid (4). Since these revisions were made, nearly $10 billion has been collected in civil verdicts under FCA, with the largest of which has
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