Medicare

Medicare's loss of billions of dollars to fraud and abuse could be curbed by adopting such private sector techniques as competitive bidding, use of advanced software to detect gross overpayments, and preferred networks to better control costs. Medicare's losses stem from inappropriate pricing and inadequate scrutiny of claims for payments. Further, abusive and poorly qualified providers of medical services and supplies continue to participate in the program. These problems are not unique to Medicare. However, private payers are often able to react quickly, through a variety of management approaches, whereas Medicare's pricing methods and controls over utilization, which were consistent with health care financing and delivery when the program started, have not been adapted to today's environment.