Fraud

I wish I could open a business in which I investigated, and reported citizens for fraud. Medicare/Medicaid/SSI/Disability/ Food Stamps.....you name it

Each of the agencies (state and federal) which administers the entitlement programs you name are subject to different rules and regulations and employ case workers and others whose job description includes preventing/addressing fraud.

Each of the agencies (state and federal) which administers the entitlement programs you name are subject to different rules and regulations and employ case workers and others whose job description includes preventing/addressing fraud.

^This.

My mother did this the last 10 years before she retired...she still is in contact with her co-workers, especially the one who took over for her.

TRUST me, there are states who are catching people and have caught people who are defrauding social programs-should there be more?? Now THAT's the question...

Also, CMS contracts nurses to do chart reviews to ensure that providers and hospitals are getting properly billed-they send nurses out to ensure and show PROOF that what a MD and/ or a nurse documents matches up to the reimbursement. If they don't, the providers don't get paid. It is tedious work, but if it isn't documented, it wasn't done nor it gets paid for. They have a total different way of reimbursing category beyond the ICD coding system...only a few of those categories are grouped under what is considered billable, especially for Medicare. I have learned what they considered "billable" depending on coverage...and it's not a lot.

So if anyone is committing "fraud", they're certainly not getting their "fraud" covered...they are getting a 20% bill every time, which adds up. THAT can be a burden. I think that may be a reason why they don't go after "the small fish" per say...they may not collect. Now, a hospital or a physican...more chances to not reimburse helps a CMS situation more than the alleged "fraudulent" individual...