Sen. Grassley: Q&A – Medicare Fraud
Q: How is waste, fraud and abuse weakening Medicare for current and future generations?
A: Seniors and people with disabilities depend on Medicare for their health care coverage, including more than 650,000 Iowans. Every dollar lost to waste, fraud and abuse rips off the taxpayer and skims resources intended for Medicare patients. That's why I keep my nose to the grindstone in
As then-chairman of the
The lion's share of Part C's improper payments are from medical record discrepancies, whereby payments weren't supported by medical records. Examples of fraudulent schemes may include upcoding, which is falsely claiming the illness or disease of a patient and billing for services at a higher level of complexity than documented; billing for unnecessary services or for services not provided; unbundling, which is submitting bills in a fragmented fashion to maximize reimbursement for tests or procedures that ought to be billed together at a reduced cost; and kickbacks, which are payments for patient referrals or for generating business. My oversight has shown risk score gaming and other waste, fraud and abuse. I've repeatedly called on CMS and the
Q: How do whistleblower laws help recover fraud?
A: Fleecing government programs is a tale as old as time. The founders of our republic took preemptive action during the Revolutionary War to curb fraud by enacting the first-ever whistleblower protections on
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Original text here: https://www.grassley.senate.gov/news/news-releases/qanda-medicare-fraud
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