Medicare: Effective Implementation of New Legislation is Key to Reducing Fraudand Abuse

摘要

Due to Medicare being one of the largest, most expensive programs in the federalbudget, program spending has been the subject of much concern and scrutiny in recent years by the Congress and the administration. This correspondence discusses Medicare fraud and abuse in both the fee-for-service and managed care programs. More specifically, it highlights (1) the impact of inadequate payment safeguard funding on efforts to combat abusive billing, (2) ineffective oversight of fee-for-service payments and operations and Medicare managed care plans, and (3) challenges that lie ahead for the effective implementation of recent legislation that addresses fraud and abuse.