Medicare¿s size and complexity make it vulnerable to fraud, waste, and abuse. Fraud represents intentional acts of deception with knowledge that the action or representation could result in an inappropriate gain, while abuse represents actions inconsistent with acceptable bus. or med. practices. Waste, which includes inaccurate payments for services, also occurs in the Medicare program. In 2009, the Centers for Medicare and Medicaid Services (CMS) estimated billions of dollars in improper payments in the Medicare program. This statement focuses on challenges facing CMS and selected key strategies that are particularly important to helping prevent fraud, waste, and abuse, and ultimately to reducing improper payments. Illustrations.

Excerpt from Waste, Fraud, and Abuse in the Medicare Program: Joint Hearing Before the Subcommittee on Health and Environment and the Subcommittee on Oversight and Investigations of the Committee on Commerce House of Representatives, One Hundred Fourth Congress, First Session, July 19, 1995 The subcommittees met at 10:04 a.m., in room 2123, Raybum House Office Building; Honorable Joe Barton and Honorable Michael Bilirakis co-chairmen presiding. Members present: Representatives Bilirakis, Barton, Hastert, Upton, Steams, Bilbray, Whitfield, Ganske, Cobum, Waxman, Brown, Stupak, Wyden, Eshoo, Klink, Bliley, and Dingell, Stafi present: Bud Albright, counsel; John Cohrssen, counsel; Cheryl Ka5mer Thomas, counsel; Eric Berger, professional staff member; Chris Knauer, investigator; and Bridget Taylor, professional staff member. Mr. Barton. The subcommittee will come to order. Today, the Subcommittee on Oversight and Investigations and the Health and Environment Subcommittee are holding a joint hearing on waste, fraud, and abuse in the Medicare system. Estimates of the dollar cost of fraud in the Medicare system run upwards of $20 billion. The cost in terms of program integrity are immeasurable. As the Chairman of the Oversight and Investigations Subcommittee, I am determined to see that the peoples money is more prudently managed than it is today in Medicare. Medicare taxes should be spent for the health care costs of our elderly and nothing else. Taxpayers work hard to earn the money that the Government exacts from them to pay their taxes, and they deserve better than having $20 billion worth of taxes shoved at them each year simply to cover waste, fraud, and abuse in Medicare. Medicare trust funds are in serious trouble. Part A will go broke within 10 years if nothing is done, and Part Bis imperiled in the long term. Part of my effort to strengthen both Medicare trust funds must include seriously dealing with waste, fraud, and abuse. This and other hearings like it seek to develop the reason, or at least part of the reason, tens of billions of dollars flow down the fraud waste trap each year. In past years, my predecessor. Chairman Dingell, has held similar hearings, but nothing apparently has structurally changed. It should not take years to correct policies that breed over billing. About the Publisher Forgotten Books publishes hundreds of thousands of rare and classic books. Find more at www.forgottenbooks.com This book is a reproduction of an important historical work. Forgotten Books uses state-of-the-art technology to digitally reconstruct the work, preserving the original format whilst repairing imperfections present in the aged copy. In rare cases, an imperfection in the original, such as a blemish or missing page, may be replicated in our edition. We do, however, repair the vast majority of imperfections successfully; any imperfections that remain are intentionally left to preserve the state of such historical works.