Discussion Question: Compare and contrast Medicare and Medicaid; Medicaid and Medicare target different groups of people the difference between Medicare health insurance for anyone with a qualifying work history who's 65 or older. Also certain younger people with certain disabilities or end-stage renal disease. By contrast Medicaid is specifically designed to help cover medical cost for people with limited income and financial resources. Medicaid can cover the cost of nursing homes, assisted living facilities, other long-term care as long as they deemed medically necessary. Medicaid and Medicare is states govern a lot of what Medicaid covers while the federal government runs Medicare. Medicaid is a joint federal and state program. The two programs are different, but both have the goal of providing health care to those who qualify. …show more content…
Fraud is a ploy to received unearned reimbursement for services not rendered. This leads to increased Medicare premiums and less payment to provider. Some providers choose not to participate in the Medicare programs. Inappropriate actions or behaviors against the Medicare program that are identified by the provider but not remedied may be considered fraudulent by Medicare. Providers who participate in Medicare program are expected to furnish and report services in accordance with the established regulations and policies. 1. Billing for services that were not rendered. 2. Misrepresenting as medically necessary any non covered or screening services by reporting covered procedure/revenue codes. 3. Singing blank records or certification forms or falsifying information on records or certification forms for the sole purpose of obtaining payment. 4. Consistently using procedure/revenue codes that describe more extensive services than those actually