In Medicare Fraud is defined as an act whereby a medical officer deliberately bills for a service that was never offered to a patient. Abuse, on the other hand, refers to the payment of services or items that were mistakenly billed and should however not be paid for (Catalano, 2009) . Fraud and abuse are both potentially illegal and unethical acts that can get medical officers into troubles. Due to the numerous negative impacts that fraud and abuse have brought in healthcare centers, various practices have been introduced to help reduce these unethical and illegal acts in Medicare.
One practice that has proven to be effective in controlling fraud and abuse in Medicare, is through proper recordings. Once a patient receives a healthcare service or gets a doctor’s appointment, he/she is advised to always record the dates on a calendar (Harrington, 2015) . Other than just recording the dates, patients should as well take notes of the tests and services that he/she receives on those particular dates. In addition to that, it is also important for a patient to properly keep files of receipts and statements that they are given by their healthcare providers (Terra, 2009) . These practices are certainly effective in reducing incidents of fraud and abuse in Medicare since both medical officials and the patient have their own recordings which can be used for comparison.
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Fraud and abuse performed against the Medicaid and Medicare system have a direct impact on taxpayers. This is because it is through a payroll tax on both employees as well as the employer that Medicare is founded. More taxes are raised when there is a need for more funds. Therefore, fraud and abuse affect everyone who is employed (Kalver, 2010) . If a healthcare organization has a health-care plan that is company rated, then fraud would directly affect the organization’s claims hence also affecting organizations ratings.
Reference
Catalano, K. (2009). Pay-for-performance and recovery audit contractors: the whys and wherefores of these programs. Plastic Surgical Nursing , 29 (3), 179-182.
Harrington, M. K. (2015). Health Care Finance and the Mechanics of Insurance and Reimbursement . Jones & Bartlett Publishers.
Kalver, B. (2010). Avoiding fraud and abuse in the medical office . Chicago: American Medical Association.
Terra, S. M. (2009). Regulatory issues: recovery audit contractors and their impact on case management. Professional case management , 14 (5), 217-223.
