Medicare is a federal health insurance program for a person that caters for the aged people’s health bills and those for younger people suffering from End-Stage Renal Disease and those receiving Social Security Disability Insurance (Brooks, Button, & Gee, 2012) . The program is funded by the taxpayers whose 1.45% of total earnings are deducted in accordance to the Federal Insurance Contributions Act, and the senior citizens are automatically enrolled as soon as they turn sixty-five (Karuppan, Dunlap & Waldrum, 2016) . The insurance program covers different medical services including hospital insurance, medical insurance, Medicare advantages plans, and prescription drugs coverage (Shaw, Asomugha, Conway & Rein, 2014). The hospital insurance caters to the patients' bills in a hospice, nursing facility, as well as some home-based care bills. Medicare insurance pays for some treatments, out of hospital care, medical equipments, and preventive services (Medicare, 2016) . The Medicare Advantage plan is a collaboration between Medicare and private companies that provides for the provision of hospital and medical insurance to be billed to Medicare and the Medicare prescription drug coverage is offered by insurance companies (Brooks et.al., 2012) . Medicare health insurance program is however faced by frauds and abusers of the service crimes committed by healthcare providers and suppliers, business owners and employees, and patients using Medicare and Medicaid.
Medicare Fraud and Abuse: Problem Statement
The Medicare program is faced by Medicare fraud and Medicare abuse problems that have social and economic implications on the taxpayers, the government, health providers and taxpayers and other stakeholders in the healthcare (Harris, 2014). Medicare fraud involves the submission of falsified cases with the aim of claiming health reimbursement for the dishonest case and obtaining money fraudulently (Shaw et.al., 2014) . Medicare abuse, on the other hand, encompasses the illegal activities that directly or indirectly lead to unplanned costs to the Medicare program or violate the patients’ rights of access to health care (Brooks et.al., 2012). There are various types of Medicare fraud and abuse, and they are perpetrated by both the medical practitioners and the patients themselves.
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Medicare fraud leads to unnecessary expenses for the government which has negative implications both socially and economically (Medicare, 2016). The Medicare abuse and fraud leads to increased expenses by the government on the healthcare sector money which could be channeled to other development projects in other sectors of the economy (Kraft & Furlong, 2014) . The increased expenses also lead to increased tax burdens on the taxpayers since the government has to find ways of funding the deficits created by the increasing healthcare expenses caused by the vices (Kinney, 2016) . It also leads to massive wastage of healthcare resources and a 2017 insurance fraud and abuse report by the Insurance Information Institute shows that resources worth over $300 billion are lost to insurance frauds annually (Brooks et.al., 2012) . The fraudulent activities also lead to higher premium costs for patients and lower the patients’ health outcomes while increasing their co-payments. In the case of Medicare abuse where the health practitioners withhold medications, or the patients collude with criminals to sell their medications the patients' welfare is put at risk (Medicare, 2016) . Some patients also fake illness and undergo medical procedures which negatively affect their health and could even lead to a shortened lifespan for the elderly.
Medicare fraud and abuse also compromise the development of the healthcare sector since it affects the results of drug trials when patients fail to follow through with their full prescriptions due to abuse by medics or the selling of the test drugs to other individuals (Brooks et.al., 2012) . Patients who collude with healthcare practitioners to fake medical history or they fake illnesses endanger their future insurability and considering that they are above 65 they become a social burden to their relatives and communities if discovered (Harris, 2014) . Medicare fraud and abuse cases also increase the volume of healthcare claims and lead to the slowdown of the processing of the genuine cases, therefore, affecting the health outcomes of the innocent patients (Shaw et.al., 2014) . The vice, therefore, increases the political, economic and social costs and if not addressed will continue to affect the healthcare sector, the general population and the government (Brooks et.al., 2012) . The problem, therefore, needs to be addressed, and permanent or at least more stringent measures of curbing it employed at the healthcare facility level as well as at the national government level.
Forms of Medicare Fraud and Abuse
Medicare Fraud occurs when healthcare providers or patients knowingly submit, or lead to the submission of untrue claims or misrepresent facts with the aim of obtaining Federal health care payment for which would have been illegible under different circumatances (Harris, 2014). Fraud also occurs when medical services providers consciously ask for, accept, offer, or pay a bribe to coerce the receipt of referrals for items tenders billable to the Federal health care programs to them or their partners for personal gain (Kinney, 2016). Fraud is also perpetrated by making illicit referrals for specified health services whereby the healthcare practitioners send patients to specific specialists or healthcare facilities in return for an agreed payment (Karuppan et.al., 2016) . Medics also commit fraud when they bill Medicare for missed appointments by pretending that they conducted medical sessions with the patients when they never showed up (Kinney, 2016). Some medical practitioners also engage in Medicare fraud when they k nowingly bill the program for services using inflated figures as opposed to the standard amount indicated on their files or pay bribes to get referrals for Medicare beneficiaries.
Medics at times also bill Medicare for unprovided services also referred to as upcoding or for undelivered medical equipment supplies through the falsification of documents to show that the equipment were indeed delivered (Medicare, 2016) . Patients also engage in medical identity theft whereby they seek to defraud the program by pretending to be other people to access the services and benefits entitled to the real identity owner (Kinney, 2016). Others also engage in physician shopping fraud whereby they consult multiple times with different doctors to get prescriptions which they later sell or use against the doctor’s directions (Brooks et.al., 2012) . Physicians also commit fraud by conducting unnecessary tests and procedures on the patients and also engage in unbundling and double billing (Medicare, 2016) . Individuals also commit fraud by offering kickbacks while the healthcare services providers commit fraud by accepting them with the aim of gaining illegal benefits from the doctor (Kinney, 2016). The issuance of inadequate medical documentation and billing Medicare for patients who are not eligible for the program are also common forms of Medicare fraud alongside off-label marketing of pharmaceutical products (Shaw et.al., 2014). Physicians also engage in self-referrals when they send patients to other facilities they run or partner in to get services billable to the Medicare health program.
Medicare abuse, on the other hand, entails the practices that violate the patients' rights to access health care services provided by the Medicare program as well as activities that are contrary to standard ethical practices (Kraft & Furlong, 2014) . Medicare abuse includes the manipulation of the billing system by the physicians leading to unnecessary reimbursements from the carrier or differentiating prices for the same goods or services for different carriers leading to overcharging of some (Harris, 2014) . Medics also subject their patients to unnecessary procedures with the aim of receiving reimbursement without regard for the effects these tests and procedures may have on the patients’ health (Shaw et.al., 2014) . The impersonation of medical practitioners with the aim of obtaining patients' medical records is also a form of Medicare abuse or persuading the patients to sell their prescribed drugs to someone (Karuppan et.al., 2016). Medicare abuse is also experienced when the patient is blocked from accessing medical services due to discrimination based on their age, ethnicity, race, health, religion, and sex or income levels (Brooks et.al., 2012). Healthcare practitioners also order patients to go for more consultations than necessary to increase their billable hours which in turn leads to inconveniences to patients considering most of the Medicare beneficiaries are the elderly and disabled people.
The impersonation of Medicare and social security officials with the aim of getting patients personal information for malicious use is also considered a form of Medicare abuse (Kinney, 2016) . The solicitation to illegally buying Medicare prescription drug cards or the encouragement of a patient to disenroll from the Medicare program is also considered as Medicare abuse (Harris, 2014) . If the patient is also bribed or offered any form of coercion to register for a Medicare prescription drug plan or is given presents exceeding $15 to sign up for a Medicare prescription drug plan it is considered Medicare abuse and the solicitor is liable for criminal charges (Shaw et.al., 2014) . The failure of pharmacists to give the patient the full dosage of prescribed drugs, the patient is charged for medications that they didn’t receive and being double charged for premium costs are also forms of Medicare abuse (Brooks et.al., 2012). Additionally, when the Medicare prescription drug plan fails to cater for all covered drugs and the patient has issued with a different drug apart from the doctor's prescription, it is considered healthcare abuse (Harris, 2014) . Therefore the difference between the Medicare fraud and Medicare abuse is in the intent of the perpetrators whereby the Medicare frauds intend to increase costs to the program while the abusers interfere with the provision of Medicare services to the patients (Karuppan et.al., 2016). The causes of the Medicare fraud and abuse are therefore diverse and can be affected by policy actions in various ways.
Policy Alternatives
Following the increased incidents of Medicare fraud and abuse, the government has put in place measures to counter the vices (Kinney, 2016) . The policy actions can lead to the reduction in the occurrences of the incidents that lead to Medicare abuse and Medicare fraud by enforcing strict legal penalties for those facing charges of any of the causes (Medicare, 2016). The policy alternatives were formulated with the aim of reducing and finally eliminating the occurrence of the fraud and abuse cases tied to various objectives (Brooks et.al., 2012). The policies aim at detecting suspicious claims before they are paid since that way the Medicare program will avoid making any unwarranted payments to the perpetrators of the Medicare fraud and abuse (Karuppan et.al., 2016). They also aim at identifying and eliminating the unethical and corrupt partners from the service provision and the supply of products to reduce the recurrence of fraudulent activities (Medicare, 2016). The policies also aim at screening the Medicare partners to ensure that noncompliance and corruption are discouraged and to stop the enrollment of bad actors (Shaw et.al., 2014) . These policies include the federal false claims act, the anti-kickback statute.
The Federal False Claims Act (FCA)
The civil FCA protects the Federal Government from paying higher than prevailing market prices or buying inferior goods or services and imposes civil liability on traders who knowingly hand in, or causes the submission of, an untrue or fraudulent claim to the Federal Government for reimbursement (Kinney, 2016) . The words “knowing” and “knowingly” show that a perpetrator of the crime is well informed or deliberately ignores the information and fakes the information tied to the claim (Karuppan et.al., 2016). The act provisions hold any individual liable if found taking part or being party to certain actions including the presentation of fake claims for payment, falsifying claims, conspiracy to violate the false claims act and presenting unverified information to government programs for payment (Harris, 2014) . The anti-retaliation provision allows the relator to recover their award for whistleblowing and double damages as well as attorney fees for any retaliatory acts (Kinney, 2016) . Medicare fraud cases prosecutable by this law include for instance a healthcare provider who knowingly submits claims to Medicare for different services than the services provided or doctors the records to reflect so (Brooks et.al., 2012). If the practitioner fails to return the surplus amount then the act holds him liable for the retention of overpayment and can be penalized for the recovery of up to thrice the amount of losses incurred by the state in addition to penalties of up to $21,916 per each false claim filed (Shaw et.al., 2014) . There is also a possibility of facing jail time and paying the fines at the same time if the charges are presented under a criminal FCA statute.
The Anti-Kickback Statute (AKS)
The anti-kickback statute is a criminal statute that provides for the prosecution of parties who willfully solicit, offer, pay or receive money with the aim of getting referrals reimbursable by the healthcare insurance (Williams, 2015) . The statute provides for the prosecution of both parties engaging in the illegal transactions, and if found guilty the criminals can be fined up to $25,000 and be incarcerated for up to five years for a single violation under the Anti-Kickback Statute (Karuppan et.al., 2016). When a service provider propounds, remunerates, asks for, or receives unlawful payment they violate the Anti Kickback Statute like in a case where a provider receives a bribe or charges rent at less than the normal amount for medical office space so as to be given preferential treatment during referrals (Williams, 2015) . If convicted, the provider is fined up to $73,588 and an additional amount of triple the total value of the kickback in addition to $74,792 per kickback (Karuppan et.al., 2016). Criminal penalties for violating the Anti-Kickback Statute may include fines, incarceration, or both jail time and fines. Additionally, the conviction of such crimes leads to the exclusion of the provider from the Medicare service providers and from any other federal healthcare programs (Harris, 2014) . The Anti Kickback Statute does not provide for the presentation of fraud cases by individual citizens, but they may may bring qui tam actions alleging violations of the Anti-Kickback Statute (Kinney, 2016) . In the case where the individual sues on behalf of the state, they are entitled to the whistleblower reward which is usually a certain percentage of the money acquired from the fines.
Physician Self-Referral Law (Stark Law)
The Physician Self-Referral Law proscribes medical practitioners from referring Medicare beneficiaries to preferential health service providers’ enterprises in which the medical practitioner or a close relative have a stake, have invested money in, or have an interest or a reimbursement arrangement (Karuppan et.al., 2016). For instance, if a healthcare provider referred a Medicare beneficiary to a designated health service provider with whom they partner or have a compensation arrangement, they would be charged with the violation of the Stark Law (Williams, 2015) . However, there are exceptions to the referral prohibition for Advanced Imaging Services. The services include Magnetic Resonance Imaging (MRI), Computerized Axial Tomography (CT), and Positron Emission Tomography (PET) (Medicare, 2016). The physician is however required by law to give the patient at least five referrals within a 25-mile radius of the physician’s office location at the time of the referral (Guzy, 2015) . Penalties for practitioners who break the Stark Law include fines up to $24,25 for every service, repayment of claims, and potential exclusion from all Federal health care programs.
The Criminal Health Care Fraud Statute
The Criminal Health Care Fraud Statute proscribes intentionally and freely taking part in or trying to take part in , a plot or treachery with the intention of defrauding a health care benefit program (Shaw et.al., 2014) . The statute also proscribes intentionally and freely taking part in or attempting to execute, a plot or artifice that seeks to use fraudulent pretenses to obtain cash or property overseen by the health care benefit program (Williams, 2015) . For instance when caregivers and medical clinics engage in a conspiracy to defraud the Medicare Program through the submission of medically unnecessary claims for power wheelchairs they can be charged under this law (Kinney, 2016) . The Penalties for violating the Criminal Health Care Fraud Statute may include fines, incarceration, or both.
Additional Medicare Anti Fraud and Abuse Policy alternatives
Apart from the civil and criminal actions taken by law enforcement agencies, the Medicare Program has put in place other administrative alternatives applicable to specific fraud and abuse violations (Kinney, 2016) . The Exclusion Statute is a section of the Social Security Act (SSA) and outlines the circumstances under which individuals or entities can be banned from partnering in Medicare and other healthcare programs (Karuppan et.al., 2016). The Office of the Inspector General uses the statute in the exclusion of individuals and entities from Medicare and Medicaid and anyone with a prior criminal record from past Medicare fraud, and abuse accusations are ineligible for partnering with any federal health care program (Kinney, 2016) . Also, the individuals and entities tied to other criminal activities related to the procurement of products or services under Medicare healthcare program, abuse or neglect, or criminal records for other health care-related misdemeanors are excluded from partnerships with federal healthcare programs (Williams, 2015) . Theft or embezzlement, criminal prosecution for unlawful production, distribution, prescription, or supplying of controlled substances is also excluded (Karuppan et.al., 2016). These exclusions are called mandatory exclusions while the permissive exclusions include prior obstruction of audits or investigations, license suspension, ownership of a sanctioned entity and defaulting educational loan and scholarship obligations (Kinney, 2016) . The statute also spells out the length of time the exclusion should last, steps taken during the exclusion process and the requirements for termination of the exclusion for the individual or entity.
The civil monetary penalty law spells out the various civil money penalties to be imposed on individuals and entities that violate the law (Kinney, 2016) . The law provides for the prosecution of individuals and entities who knowingly engage in the presentation of false claims about the provision of goods and services billable to the Medicare health program (Dipietro & Klingenmaier, 2013) . It also provides for the prosecution of people who knowingly give or cause the dissemination of falsified information that is likely to influence the discharge of a patient (Kraft & Furlong, 2014) . The individuals and entities who give bribes to Medicare beneficiaries to affect their receipt of products or services billable to the federal healthcare programs are also prosecuted under this law (Dipietro & Klingenmaier, 2013) . The healthcare providers who collude with individuals or entities that have been excluded from the healthcare programs partnerships are also charged under the monetary penalty law (Williams, 2015) . The monetary penalty law also provides for the prosecution of individuals and entities who intentionally or readily issue or receive bribes for referrals of Medicare healthcare program beneficiaries (Dipietro & Klingenmaier, 2013) . The Monetary Penalty law also prosecutes the individuals or entities who misappropriate the payments allocated to Medicare healthcare program beneficiaries and use it for the purposes it was not intended for.
Medicare also recognizes the impact that a public and private sector partnership could have on the reduction and elimination of the Medicare fraud and abuse vices (Guzy, 2015) . The federal healthcare programs have established a Health Care Fraud Prevention Partnership (HFPP) which is a voluntary public and private sector partnership between State agencies, law enforcement, private health insurance plans, and health care anti-fraud associations (Kinney, 2016) . The partnership is aimed at recognizing the Medicare fraud and abuse perpetrators from the healthcare facility level to help stop their activities before they get reimbursed by the system (Dipietro & Klingenmaier, 2013) . The program has also established the Centers for Medicare & Medicaid Services (CMS) mandated with the prevention and detection of healthcare abuse and fraud cases (Williams, 2015) . The organization works in liaison with individuals’ entities, and law enforcement agencies like healthcare providers, hospices, suppliers and other accredited organizations (Kraft & Furlong, 2014) . The office of the attorney general also works in conjunction with the federal healthcare programs in the implementation and formulation of anti-Medicare fraud and abuse laws.
The Center for Program Integrity also plays a critical part in the fight against the Medicare fraud and abuse crimes by uniting the Medicare and Medicaid program integrity groups under one management structure (Shaw et.al., 2014) . The program is tasked with the screening processes for providers and suppliers before they are contracted to work with the Medicare, Medicaid healthcare programs (Kraft & Furlong, 2014) . The program also facilitates the cross-termination among federal and state health programs which ensures that the individuals and entities that have been excluded from any of the federal healthcare programs stay blacklisted from all the programs to avoid subsequent involvement in fraud, waste, and abuse (Karuppan et.al., 2016). The Center for Program Integrity is also tasked with the temporary halting of enrollment of new providers and suppliers in high-risk areas and look out for potential areas where Medicare fraud and abuse is more likely to appear.
The physicians also play a significant part in the anti-Medicare fraud and abuse efforts and a fraud and abuse detection and prevention program is a tool used to reduce the Medicare waste, fraud and abuse at the hospital and healthcare facilities level (Kinney, 2016). Many physicians, caregivers, and healthcare practitioners were charged with perpetrating Medicare fraud and abuse or for facilitating the vices, but there still are outstanding healthcare professionals (Karuppan et.al., 2016). Over 8000 medical practitioners are presently excluded from participation in the federal health care programs in relation to various forms of healthcare programs fraud and abuse so they cannot attend to the over 90 million Medicare beneficiaries (Harris, 2014) . The education of the doctors on laws formulated to prevent fraud, waste, and abuse would help them partner with the public and private sector Medicare anti-fraud and abuse teams (Williams, 2015) . The partnership will ensure that the finances currently lost to fraud, waste, and abuse in the system are used in improving the service provision to Medicare beneficiaries (Shaw et.al., 2014) . The already exists laws that protect whistleblowers and reward them and educating the physicians on the gravity of the Medicare fraud and abuse effects will encourage them to take action (Dipietro & Klingenmaier, 2013) . The physicians are in a special position to identify the fraudsters since they act as a liaison between the patients and the healthcare programs and bridging the information gap on fraud and abuse detection, prevention and reporting will help avoid the filling of ineligible claims for the Medicare program reimbursement.
The Evaluative Criteria for Medicare Fraud and Abuse policy alternatives
The fight against Medicare fraud and abuse can be won through the intensified collaboration between the private and the public sectors and other stakeholders a criterion that can be offset by a two-way information sharing arrangement (Guzy, 2015) . An information asymmetry exists between the public and the private sector as well as between the two sectors and the public (Dipietro & Klingenmaier, 2013) . Stakeholders in the healthcare sector, the beneficiaries and those close to them have the potential of whistleblowing on corrupt suppliers, colleagues, and beneficiaries of the Medicare program to stop the vices before they are even reimbursed (Kraft & Furlong, 2014) . The Department of Health and Human Services (HHS) and the Department of Justice (DOJ) have been working closely to eliminate the Medicare fraud and abuse crimes. The partnerships have seen the number of fraud and abuse cases drop exponentially and if they increase the public engagement in the process more millions of dollars are likely to be saved (Karuppan et.al., 2016). The information sharing can be facilitated through strengthening the already existent frameworks like the hotlines and ensuring that the identities of whistleblowers are protected since some people fear coming forward with information for fear of retribution.
The detection of the Medicare fraud and abuse cases before the perpetrators seek payment through prepayment reviews will also play a significant role in the reduction of the Medicare fraud and abuse cases (Dipietro & Klingenmaier, 2013) . Considering that the majority of the Medicare fraud and abuse cases result from the billing practices a thorough review of claims by both private and public insurers can help detect fraud and abuse before the reimbursement process takes place (Kraft & Furlong, 2014) . The strict implementation of the Reconciliation Act which repeals the previous statutory limitations on review of new providers enables the insurers to identify fraud and abuse before any money is paid for any claims through thorough prepayment reviews. Implementation of the proposed review will go a long way in stopping the vices (Dipietro & Klingenmaier, 2013) . More resources and funding are also required to boost the already existent anti-fraud Medicare programs through structural program changes and funding of research and development. Additionally, the implementation of the Reconciliation Act which repeals the previous statutory limitations on review of new providers presents insurers with the opportunity to detect cases of fraud and abuse before any money is paid (Medicare, 2016). Implementation of the proposed review will go a long way in stopping the vices.
With the technological advancement in the Medicare fraud and abuse federal healthcare programs, criminals have invented ways of avoiding detection by analysts and auditors which calls for the establishment of a more stringent alternative to catch them (Dipietro & Klingenmaier, 2013) . The creation of a Medicare fraud strike force at the federal level will reduce the vices and enable closer scrutiny of the Medicare programs suppliers, beneficiaries and the healthcare providers working with them (Kraft & Furlong, 2014) . Fraudsters have invented new ways of defrauding the Medicare programs including through money laundering, shell corporations, cartels, tax evasion and kickback schemes (Guzy, 2015) . If the Medicare Fraud Strike Force replicates its national success through the collaboration with HHS, Office of Inspector General, Federal Bureau of Investigation, and Internal Revenue Service at the federal level there will be a massive reduction in the Medicare fraud and abuse cases.
There is also an imminent need for an upgrade of the data systems to enable the integration of different data processing system to facilitate Medicare fraud detection at all levels (Kraft & Furlong, 2014) . Upgrading the Integrated Data Repository (IDR) and the One Program Integrity (One PI) Web portal with its array of analytic tools will facilitate the data analysis of supplier details, Medicare beneficiaries’ records and the healthcare providers’ services and pricing (Dipietro & Klingenmaier, 2013). The ability to regionalize the integrated data repository and integrate the regional and state data will go a long way in ensuring that the Medicare fraud and abuse cases are detected and reported to the relevant authorities promptly (Dipietro & Klingenmaier, 2013). To protect the Medicare abuse whereby suppliers give patients expired drugs endangering their lives and compromising their health the government through the FDA should establish a law that requires the drug manufacturers to publicize the expiration dates at the NDC level.
The federal healthcare also needs to put stringent measures in place to stop ineligible payments since millions of dollars are lost to fraudsters with false claims (Harris, 2014). There is already a strategy in place to deal with the problem through the do not pay list which was established in 2010 following an auditors’ report that showed that federal agencies spent over $170 million in the payment of claims to 20,000 already dead people and over $220 million on 14,000 fugitives or criminals in prison (Kinney, 2016). These people were illegally getting benefits from the federal healthcare programs, and the number of such cases is still high and on the rise and expanding the do not pay list to net all the illegal cases will lead to saving of millions of dollars. The healthcare program can achieve this through the cross-matching of the DEA registry with the Medicare claims before payment for the claims in a weekly basis and not in more days than that (Shaw et.al., 2014). The frequent cross-checking will ensure that the deceased and incarcerated people and other ineligible people are removed from the system and make it impossible for identity thieves to use their Medicare cards illegally (Harris, 2014). A report by the General Accounting Office shows that over $800,000 was disbursed to dead Medicare recipients or prescribed by deceased providers revealing that there is a challenge in the record keeping practices in the federal healthcare programs (Kinney, 2016). An update of the Medicare management information system within a few days of a beneficiary’s death will go a long way in ensuring that the Medicare fraudulent claims are rejected on submission and avoid the costly process of hunting down the criminals after the claim is paid (Kraft & Furlong, 2014). The data management process, therefore, needs to be reviewed as one of the criteria for fighting Medicare fraud.
The costs of implementing the alternatives are incomparable to the benefits that are most likely to be accrued from the strengthening of the anti-Medicare fraud and abuse policy alternatives both in short and the long run (Dipietro & Klingenmaier, 2013). The benefits of the implementation of the other options include reduced losses for the Medicare program since the fraud and abuse cases will exponentially reduce (Kraft & Furlong, 2014). The improved information and data integration will facilitate the detection and prevention of Medicare fraud like identity theft of deceased beneficiaries, physician shopping and healthcare providers taking advantage of the patients for monetary gain (Williams, 2013). The policy alternatives will also enable the sustenance of the Medicare healthcare program low premiums since the wastage of financial resources will be exponentially reduced (Karuppan et.al., 2016) . The ability of the Medicare program to maximize the use of their resources and catch fraud before payment for the claims is made will ensure that the beneficiaries continue receiving the Medicare services at low monthly premiums (Dipietro & Klingenmaier, 2013). The policy reforms will also enable the healthcare program to continue the broad coverage of their services and continue providing and inventing numerous plan options (Guzy, 2015). The money recovered from the people convicted of the Medicare fraud and abuse can also be used to provide additional benefits to the beneficiaries.
The failure to take action against the Medicare fraud and abuse perpetrators will lead to increased wastage of resources, increased premiums increased tax burdens on the taxpayers and also compromise the beneficiaries' health outcomes. If no action is taken the social and economic implications of Medicare fraud and abuse will persist leading to increased taxes and wastage of healthcare resources (Dipietro & Klingenmaier, 2013). The patients’ health outcomes will continue to deteriorate since there will be no mechanisms to protect them against Medicare abuse and fraud. In the absence of a legal process that punishes the Medicare fraudsters who steal identities and collect claims on behalf of deceased beneficiaries, the whole system will be in chaos (Ferenc, 2014) . There will be no deterrence to such crimes, and the elderly patients will be put at risk while their health will be at risk if self-harming Medicare abuse behaviors go unchecked. The patients who engage in physician hunting and fake terminal illnesses endanger their lives, and in the absence of policies to discourage such behaviors they will continue engaging in the costly behaviors (Brooks et.al., 2012) . The absence of a system that blacklists the excluded suppliers and healthcare services providers will lead to increased corruption and fraudulent practices in the procurement and healthcare service provision (Kinney, 2016). If no action is taken, therefore, the Medicare fraud and abuse will increase endangering the patients' wellbeing and increase the expenditure of the federal healthcare programs since the cost of apprehending and prosecuting the criminals is less compared to no action (Dipietro & Klingenmaier, 2013). The benefits of implementation of the strategies, therefore, supersede the costs and the federal healthcare programs should adopt them to strengthen the already existent strategy and invent new ones to supplement the conventional strategies.
The social feasibility of the alternatives is great since they will help reduce the dependency ratio and the burden of caring for the old people on their families and the community as a whole (Brooks et.al., 2012) . When the Medicare abuse practices that undermine the health of the population are eliminated, the patients will be able to access their medications, therefore, reducing the complications of age-related conditions (Kraft & Furlong, 2014). The crackdown on fraud and abuse will also lead to the creation of crime-free societies since the fear of imprisonment will act as a crime deterrent, therefore, decreasing the fraud rates and abuse for a safer society (Dipietro & Klingenmaier, 2013). Politically, the increased detection and apprehension of the Medicare abuse and fraud perpetrators will increase government revenue due to the fines related to the crimes (Dipietro & Klingenmaier, 2013). The policies will also contribute to social equity since the fines will be used in the improvement of health services provisions to the elderly to ensure that they lead comfortable lives and they are well taken care of in the healthcare facilities that the Medicare health program pays for (Guzy, 2015) . The patients will also be protected from abuse in the form of discrimination based on their age, race, religion and the revenue will be used to further improve the healthcare sector and increase the patient outcomes across all levels.
The assessment of alternatives
The Medicare abuse and fraud policies vary from civil and criminal actions to administrative actions and public education campaigns and are aimed at increasing the detection and prevention of the Medicare fraud and abuse (Kinney, 2016) . The civil and criminal actions are the most effective forms of action compared to the other policies. Each policy carries significant weight in the battle against Medicare fraud and abuse, but most of these policies are best applied as additional policies to strengthen the legal framework and facilitate it (Guzy, 2015) . The criminal and civil systems are tasked with the investigation, prosecution, and conviction of the people who are accused of engaging in the Medicare abuse and fraud at all levels of the healthcare sector. In the criminal and civil actions system, there already are established statutes which spell out the different forms of abuse and fraud and what behaviors and practices constitute a prosecutable crime (Ferenc, 2014). The ordinances include the Stark law, the false claims act, the anti-kickback statute, the criminal health care fraud statute, the civil monetary penalties, and exclusion.
The civil and criminal actions play a significant role in the establishment of the ethical and acceptable practices in the federal healthcare (Kraft & Furlong, 2014) . While the other policy alternatives only present ways of dealing with the Medicare fraud and abuse they fail to stipulate the practices that warrant prosecution and investigation (Dipietro & Klingenmaier, 2013) . By stating the constitution of fraud and abuse the civil and criminal actions establish a foundation for the stakeholders to detect and prevent the crimes (Kinney, 2016) . The actions also deter crime since the beneficiaries of the program, suppliers and service providers and physicians know the fines, jail time and other penalties that they are most likely to encounter if they are caught engaging in the Medicare fraud, abuse, and waste. The physicians who engage in the fraud and abuse are susceptible to losing their licenses, and the suppliers and providers risk being blacklisted from all the healthcare programs (Harris, 2014) . Weighing the risks against the costs the practitioners are most likely to be discouraged from engaging from any form of Medicare fraud and abuse.
The civil and criminal actions also facilitate the whistleblowing and reporting of Medicare fraud and abuse crimes (Guzy, 2015) . In conjunction with the Center for Medicare and Medicaid Services and the Healthcare Fraud Prevention and Enforcement Action Team the laws provide for the rewarding of the people who report fraud (Dipietro & Klingenmaier, 2013) . Through the integration of these policies, the physicians and other healthcare practitioners and members of the public are encouraged to report any fraud and abuse cases which go a long way in the detection, investigation, and prosecution of the individuals and entities involved (Karuppan et.al., 2016). The civil and criminal actions also prevent the patients against unscrupulous business people by establishing the CMS marketing guidelines (Kraft & Furlong, 2014) . The suppliers and providers of healthcare services are prohibited from making home visits to Medicare beneficiaries, calling them, bribe them to subscribe to their programs or talk to them about their healthcare plans during their doctor visits (Kinney, 2016) . The Medicare beneficiaries are therefore protected from harassment or solicitation for membership to subscribe to certain healthcare plans billable to the Medicare healthcare program (Harris, 2014) . However, the civil and criminal actions are limited by the commitment of the staff in the legal processes to the eradication of Medicare fraud and abuse (Shaw et.al., 2014). Some officials are prone to coercion and bribery whereby the offenders offer them incentives to ignore their fraudulent activities for a price.
The Creation of a Medicaid Fraud Strike Force at the state level will help in the detection of fraud and facilitate the thorough screening of claims before they are paid (Kinney, 2016) . The existence of such teams at the federal level will create a synergy across the national Medicare healthcare program and facilitate the working together of the private and public sector stakeholders in the elimination of Medicare fraud and abuse at all levels of the healthcare sector (Dipietro & Klingenmaier, 2013) . The implementation of this policy will, however, be costly because it will require the hiring of more staff and the Medicare program may experience the diseconomies of scale that are experienced by very big organizations. The team will, however, facilitate the fast response to cases of fraud and abuse through the integration of federal Medicare fraud and abuse hotlines and internet-based systems around the clock (Karuppan et.al., 2016) . At a federal level there will be less bureaucracy in the decision-making process which will hasten the investigations and prosecution of the people found guilty of Medicare fraud and abuse.
The expansion of data repository through the development of Integrated Data Repository systems and the frequent updating of the do not pay list will lead to the reduction of payment of illegal claims (Dipietro & Klingenmaier, 2013) . The upgrading of the data system and the enhancement of the Medicare program data handling capability will help in the detection of fraudulent claims and stop payments which are a more effective way of dealing with fraud than going after the perpetrators after the claims are paid (Kraft & Furlong, 2014) . The system will ensure that the Medicare program gets notified every time a beneficiary dies, a provider or supplier or a physician is excluded from the healthcare program to avoid submission and payment of illegible claims (Ferenc, 2014) . The implementation and maintenance cost is however high but the benefits are great in the long run since detection and prevention of fraud will be avoided.
The increased collaboration of the public and the private sector's policy will also facilitate the minimization of the prevalence of Medicare fraud and abuse (Williams, 2015) . The education of the healthcare providers on Medicare fraud and abuse and enlisting them as partners will also strengthen the fight against Medicare fraud and abuse (Kraft & Furlong, 2014) . The collaborations will increase the awareness, detection, and reporting of the Medicare fraud and abuse cases and save the program millions of dollars (Dipietro & Klingenmaier, 2013) . The publicization of drug expiry dates will also go a long way in the reduction of Medicare abuse and protecting beneficiaries from toxic drugs while at the same time saving the program from paying for substandard goods (Shaw et.al., 2014). Through the stringent measures and policies, the level of Medicare fraud and abuse will go down, and the program will save resources and improve their service provision terms to the Medicare beneficiaries.
In sum, Medicare fraud and abuse is a prevalent problem that costs millions of taxpayer dollars. The two vices are differentiated on the intent of the perpetrator whereby Medicare fraud occurs when the criminals increase the costs of goods and services billable to the Medicare program while abuse interferes with the beneficiaries' ability to access Medicare-sponsored services. There have been criminal and civil actions put in place to deal with the crime including the anti-kickback law, the stark law, civil monetary penalties laws and the false claims act. The policy alternatives include the collaboration of the private and the public sectors and the improvement of administrative programs.
References
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Ferenc, D. P. (2014). Understanding hospital billing and coding St. Louis, MO: Elsevier.
Karuppan, C. M., Dunlap, N. E., &Waldrum, M. R. (2016). Operations management in healthcare: strategy and practice . New York: Springer Publishing Company.
Dipietro, B., & Klingenmaier, L. (2013). Achieving Public Health Goals Through Medicaid Expansion: Opportunities in Criminal Justice, Homelessness, and Behavioral Health With the Patient Protection and Affordable Care Act: American Journal of Public Health, 103 (S2). doi:10.2105/ajph.2013.301497
Guzy, N. (2015). Medicare and Medicaid Fraud: Encyclopedia of White-Collar and Corporate Crime : doi:10.4135/9781452276175.n292
Harris, D. M. (2014). Contemporary issues in healthcare law & ethics Chicago, IL: Health Administration Press.
Kinney, E. D. (2016). Curbing Fraud and Abuse in the Medicare Program: The Affordable Care Act and Medicare in Comparative Context, 112-134. doi:10.1017/cbo9781316275245.006
Kraft, M. E., & Furlong, S. R. (2014). Public policy: politics, analysis, and alternatives . Thousand Oaks, CA: CQ Press, an imprint of SAGE Publications.
Medicare Fraud & Abuse - cms.gov. (2016). Retrieved December 09, 2017, from https://www.bing.com/cr?IG=79209E5EC2F34367BC3468D7B7930680&CID=2D 6A4B5E43AF67440D2D407242A966C7&rd=1&h=tDZnldTAn6EwyccVMaPwc03 LFU5HG208pr8j7KxAcuI&v=1&r=https%3a%2f%2fwww.cms.gov%2fOutreach- and-Education%2fMedicare-Learning-Network- MLN%2fMLNProducts%2fdownloads%2ffraud_and_abuse.pdf&p=DevEx,5064.1
Shaw, F. E., Asomugha, C. N., Conway, P. H., & Rein, A. S. (2014). The Patient Protection and Affordable Care Act: opportunities for prevention and public health. The Lancet, 384 (9937), 75-82. doi:10.1016/s0140-6736(14)60259-2
Williams, J. C. (2015). A Systems Thinking Approach to Analysis of the Patient Protection and Affordable Care Act: Journal of Public Health Management and Practice, 21 (1), 6-11. doi:10.1097/phh.0000000000000150
