MO270 Unit 3 Assignment MOliver.docx - Running head MEDICARE FRAUD AND ABUSE Medicare Fraud and Abuse Michelle Oliver Purdue University Global Professor

MO270 Unit 3 Assignment MOliver.docx - Running head...

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Running head: MEDICARE FRAUD AND ABUSE 1 Medicare Fraud and Abuse Michelle Oliver Purdue University Global Professor Jennifer Claire MO 270 Unit 3 assignment
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MEDICARE FRAUD AND ABUSE 2 Medicare Fraud and Abuse Medicare Fraud Medicare Fraud is against the law and one can be penalized for committing such fraud and never allowed to work in a facility where federal funds are received. According to Medicare Learning Network (MLN), fraud happens when someone knowingly submits a claim that includes false information or misrepresentation to receive a payment that otherwise would not qualify for payment (2017, p. 3). In addition, fraud also includes requesting, accepting, or offering compensation to persuade referral for services paid for by Medicare (MLN, 2017, p.3). Lastly, MLN expressed that Medicare Fraud is also making referrals that are not allowed for certain designated health services (2017, p.3). Committing Medicare Fraud can cost taxpayers billions of dollars each year and as professionals in the medical field, we need to ethically protect the rights of the patients and ensure ourselves or co-workers are not committing fraud. An example of fraud includes a health care facility billing Medicare or Medicaid for an appointment that a patient never showed up for or billing for services that were not provided, or falsifying records (MLN, 2017, p.4). Therefore, it is essential for a medical manager to ensure staffing is trained on clean claims and include correct documentation when submitting claims to Medicare or Medicaid. This helps, not only ensure correct documentation but reduce fraud. Moreover, another example of Medicare Fraud includes paying for the referrals of beneficiaries (MLN, 2017, p.4). There is not only Fraud, but there is also Medicare Abuse as well.
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  • Spring '15
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