" GAO has designated Medicare as a high-risk program, in part because the program's size and complexity make it vulnerable to fraud, waste, and abuse. In 2013, Medicare financed health care services for approximately 51 million individuals at a cost of about $604 billion. The deceptive nature of fraud makes its extent in the Medicare program difficult to measure in a reliable way, but it is clear that fraud contributes to Medicare's fiscal problems. More broadly, in fiscal year 2013, CMS estimated that improper payments-some of which may be fraudulent-were almost $50 billion. This statement focuses on the progress made and important steps to be taken by CMS and its program integrity contractors to reduce fraud in Medicare. This statement is based on relevant GAO products and recommendations issued from 2004 through 2014 using a variety of methodologies. Additionally, in June 2014, GAO updated information based on new regulations regarding enrollment of certain providers in Medicare by examining public documents.

Medicare Fraud: Further Actions Needed to Address Fraud, Waste, and Abuse

Medicare Fraud: Further Actions Needed to Address Fraud, Waste, and Abuse

In businesses, governments, or any system involving resources, processes, and people, fraud, waste, and abuse are three separates but connected ideas that can happen. It takes a complete strategy that combines preventive, detection, and reaction techniques to address fraud, waste, and abuse. Policies, processes, controls, and training programs are put in place by businesses and governments to stop fraud, deal with waste, and deal with abusive behavior. In addition, procedures including audits, inquiries, hotlines for reporting fraud, waste, and abuse, and disciplinary measures, are employed to identify and address fraud, waste, and abuse incidents when they arise. Encouraging openness, responsibility, and moral conduct is crucial for reducing the dangers of fraud, waste, and misuse and cultivating an honest culture in businesses and society at large.