Medicare Fraud Laws

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Title XI of the Social Security Act includes Medicare and Medicaid program-related anti-fraud laws, which not only punish violators with civil and criminal penalties, but also possible exclusion from federal health care programs. The laws address Medicare fraud, which occurs when providers bill Medicare for services or supplies Medicare patients don’t receive. They also tackle the illegal activities associated with Medicare abuse–when doctors, suppliers and others don’t follow good medical practices, resulting in unnecessary costs to Medicare, improper payments, or services that aren’t medically necessary.

Having Medicare fraud laws in place is especially important given the financial toll of this type of fraud. The Medicare program makes about $500 billion in payments each year. Each year, approximately 10% of the Medicare payments are improper and the result of fraud.

Some of the more commonly used laws to fight heathcare fraud and abuse were amended in March 2010, with passage of legislation aimed at improving health care fraud and abuse enforcement, called the Patient Protection and Affordable Care Act (PPACA).

Specific laws