According to data from 2016, CMS spent around $1.1 trillion on coverage for approximately 145 million people across America, yet $95 billion of that constituted improper payments that were connected to fraud or abuse. Unfortunately, it’s estimated by the FB that fraudulent billing constitutes between 3-10 percent of total health spending, a huge driver of waste and inefficiency.
Unfortunately, mistakes that lead to administrative areas like incorrect billing or even upcoding claims can both lead to charges of Medicare fraud and abuse for your medical practice. This can result in legal consequences like being excluded from federal healthcare programs, and could even lead to the loss of professional license in some cases. Some of the laws governing Medicare fraud and abuse include the Social Security Act, United States Criminal Code, Physician Self-Referral Law, False Claims Act, and the Anti-Kickback Statute.