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Difference Between Medicare And Medicaid

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The primary difference between Medicare and Medicaid is who elegible for each program. They are both government sponsored programs, and both are designed to aid people in paying for healthcare. That is about all they have in common. Medicare is usually for people 65 or older, under 65 with certain disabilities, or for patients of any age who have End Stage Renal Disease (ESRD) or ALS. Medicare is also governed by the federal government, whereas Medicaid is for people with limited resources or income and governed by the state. Each state creates its own Medicaid programs, following federal guidelines. Medicare has 15% of the federal budget compared to Medicaid’s 10%. If you qualify for both Medicare and Medicaid, you are considered to be “dual …show more content…

Any healthcare providers who engage in improper coding, upcoding, ordering unnecessary diagnostic tests, or billing for services or supplies not rendered are subject to administrative, civil, or criminal liability. That’s why laws have been put in place against it. Medicare laws against fraud and abuse include: False Claims Act (FCA), Anti Kickback Statute (AKS), Physician Self Referral Law (stark Law), Social Security Act, United States Criminal Code. Medicaid has been on the Government Accountability Office (GAO) list of high risk programs since 2003 because it has consistently ranking second among federal programs with the highest improper payment rates. With $161 billion in improper payments, fraud is a huge concern for Medicaid as well. Patients may commit fraud by submitting false claims for services not rendered and products not received, or by altering the amount of a claim. Patients can also see many providers for the same condition to get more medication for the same condition. This is usually done to support an addiction or to resell the pills for money. CMS now requires physicians seeing Medicaid patients to use tamper resistant prescription

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