Preventing Fraud And Abuse Managed Care

Needs to be about 2 pgs. With references. Needed by 5pm central time tomorrow!!

I. Challenges and Problems Associated with Fraud and Abuse in Managed Care
Fraud and abuse in managed care is not without any challenges and problems.
A. Overbilling
1. Patients are billed for services not performed.

on them.
2. Patients are falsely billed for higher-priced.

treatment, also known as “upcoding”. Patients’

diagnostic results are inflated to show a more

serious medical condition that it really is
B. Falsification of patients’ tests to justify diagnostic results, medical procedures, or surgery that are not required

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