Fraud and Abuse

Medicare Continues to Be Vulnerable to Exploitation by Unscrupulous Providers Gao ID: T-HEHS-96-7 November 2, 1995

The vast majority of Medicare providers try to abide by program rules and strive to meet beneficiaries' needs. Nevertheless, Medicare is overwhelmed in its attempts to keep pace with, much less stay ahead of, those bent on cheating the system. GAO's recent investigations of Medicare fraud and abuse have implicated home health agencies, medical suppliers, pharmacists, rehabilitation therapy companies, and clinical laboratories. They are attracted by the high reimbursement levels for some supplies and services, and the few barriers to entry into this lucrative marketplace. Once engaged in these profitable activities, exploitative providers too often escape detection because of inadequate claims scrutiny, elude pursuit by law enforcement authorities because of the authorities' limited resources and fragmented responsibilities, and face little risk of speedy or appropriate punishment.



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