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In the United States, Medicare fraud is the collection of Medicare health care reimbursement under false pretenses. There are many different types of Medicare fraud, all of which have the same goal: to collect money from the Medicare program illegitimately. The total amount of Medicare fraud is difficult to track, because not all fraud is detected and not all suspicious claims turn out to be fraudulent. According to the Office of Management and Budget, Medicare "improper payments" were $47.9 billion in 2010, but some of these payments later turned out to be valid.〔(politifact.com ) (2011-01-04). Retrieved on 2011-01-05.〕 The Congressional Budget Office estimates that total Medicare spending was $528 billion in 2010.〔(【引用サイトリンク】title=The Budget and Economic Outlook: Fiscal Years 2010 to 2020 )〕 The Medicare program is a target for fraud because it is based on the "honor system" of billing. It was originally set-up to help honest doctors who helped the needy with medical services. == Types of Medicare fraud == Medicare fraud is typically seen in the following ways: # Phantom Billing: The medical provider bills Medicare for unnecessary procedures, or procedures that are never performed; for unnecessary medical tests or tests never performed; for unnecessary equipment; or equipment that is billed as new but is, in fact, used. # Patient Billing: A patient who is in on the scam provides his or her Medicare number in exchange for kickbacks. The provider bills Medicare for any reason and the patient is told to admit that he or she indeed received the medical treatment. # Upcoding scheme and unbundling: Inflating bills by using a billing code that indicates the patient needs expensive procedures. A 2011 crackdown on fraud charged "111 defendants in nine cities, including doctors, nurses, health care company owners and executives" of fraud schemes involving "various medical treatments and services such as home health care, physical and occupational therapy, nerve conduction tests and durable medical equipment." The Affordable Care Act of 2009 provides an additional $350 million to pursue physicians who are involved in both intentional/unintentional Medicare fraud through inappropriate billing. Strategies for prevention and apprehension include increased scrutiny of billing patterns, and the use of data analytics. The healthcare reform law also provides for stricter penalties; for instance, requiring physicians to return any overpayments to CMS within 60 days time.〔(Westgate, Aubrey "Medicare Fraud and Abuse and Your Practice" ). "Physicians Practice". May 2012.〕 In recent years regulatory requirements tightened and law enforcement has stepped up. 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「Medicare fraud」の詳細全文を読む スポンサード リンク
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