Medicare, Medicaid Managed Care Gets Scrutiny for Fraud
By Theo Francis
As the government increases the private sector's role in delivering Medicare and Medicaid services, new kinds of fraud are cropping up that are harder to spot, more complicated to prosecute and potentially more harmful to patients. Now, regulators are belatedly ramping up scrutiny of the managed-care industry, which has grown to cover more than 37 million state and federal beneficiaries.
Managed-care fraudsters profit by, among other means, shortchanging patients or physicians to cut costs while collecting preset fees from the government. They might refuse to enroll unhealthy people, skimp on paying doctors or deny patients care.
Abridged.
SOURCE: wallstreetjournal
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