Medicare: Fraud and Abuse Control Pose a Continuing Challenge

摘要

As your Committee prepares for a hearing to examine how to prevent losses from211u001efraud and abuse in federal programs, you asked us to summarize our findings on 211u001esafeguards in the Medicare program. At your request, this report discusses fraud 211u001eand abuse in both Medicare's fee-for-service (the traditional Medicare program in 211u001ewhich beneficiaries may choose their own providers) and managed care programs (in 211u001ewhich beneficiaries select a managed care plan and must use only providers 211u001eparticipating in that plan). More specifically, the report highlights (1) the 211u001eimpact of inadequate program safeguard funding on efforts to combat improper 211u001eMedicare payments, (2) ineffective management and oversight of fee-for-service 211u001epayments and operations, and (3) ineffective oversight of Medicare managed care 211u001eplans.