Medicare and the ACA: Shifting the paradigm of fraud detection

Authors

David P. Paul III
Sarah Clemente
Ronald McGrady
Rob Repass
Alberto Coustasse, Marshall UniversityFollow

Document Type

Article

Publication Date

Fall 2016

Abstract

Medicare fraud and abuse costs are estimated at 3%-10% of overall Medicare spending, which is expected to expand considerably until 2024 and as such the amount of fraud dollars would be expected to increase proportionally. The purpose of this research was to determine how recent reforms, especially the Patient Protection and Accountable Care Act, may affect Medicare fraud and abuse and to uncover the best strategies to combat Medicare fraud. The breadth of fraud and abuse within Medicare as well as recent reforms to fight fraud including legislative reforms, delivery system reforms, and other reforms including the formation of HEAT fraud fighting taskforces are examined. Legislative reforms are noted to be incompatible with the ACA’s new P4P delivery and reimbursement reforms. Medicare fraud requires comprehensive detection and prevention measures. Benefits of implementing this dual method of fraud fighting are discussed.

Comments

Paper presented at Academy of Business Research Fall 2016 Conference, Atlantic City, NJ. Copyright © 2016 The Authors. All rights reserved.

Recommended Citation

Paul III, D. P., Clemente, S., McGrady, R., Repass, R. & Coustasse, A. (2016, September). “Medicare and the ACA: Shifting the paradigm of fraud detection.” Presentation at Academy of Business Research Fall 2016 Conference, Atlantic City, NJ.