They want us to identify examples of Medicaid and Medicare fraud and abuse.

We want to believe that all health care workers are honest and operate with integrity. Unfortunately, there are quite a few people who have ulterior motives and seek to take advantage of the system.

Research Medicare fraud cases. Pick a case to analyze, using the framework provided by the template below:

Unit 5 Assignment: Fraud Case Analysis Where did the fraud occur? [your response here] What was the health care setting? [your response here] How was the fraud detected or reported (if known)? [your response here] Provide your hypothesis for the following questions: How could this fraud have been prevented or detected sooner? [your response here] What organizational protocols could have reduced the occurrence? [your response here] What people could have been more empowered to reduce the occurrence, or to report sooner? [your response here]

References:

OIG. (2020). FY2020 health care fraud and abuse control program annual report. https://oig.hhs.gov/publications/docs/hcfac/FY2020-hcfac.pdf

U.S. Department of Justice. (2018, February 26).Selected cases.https://www.justice.gov/archives/opa/selected-cases

Unknown. (n.d.).Fraud case study medically unnecessary procedures.https://www.dodig.mil/Portals/48/Documents/Components/PO/APO/Fraud-Resources/GenFraudScenarios/FCS_MedicallyUnnecessaryProcedures.pdf