Health Care Fraud As It Affects the Aging Hearing Before the Special Committee

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Since the first CMP was enacted in 1981, Congress has greatly expanded this authority to apply to such improper practices as (1) hospitals and physicians making and receiving payments in order to induce the reduction or limiting of services provided to program beneficiaries; (2) health maintenance organizations failing to provide medically necessary items and services; (3) individuals and entities engaging in certain misleading or fraudulent practices with respect to the marketing or selling of
... supplemental (medigap) insurance policies and (4) "patient dumping. " The law and implementing regulations for these administrative sanctions provide for due process to be afforded to sanctioned providers and practitioners through review by an administrative law judge, the Departmental Appeals Board, and ultimately the Federal courts.
Medicare and Medicaid Fraud and Abuse Vulnerabilities Fraud is invisible until detected. Because of that fact, it is extremely difficult to estimate the total monetary loss as a result of fraud in the health care industry.


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