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Medicare and the ACA: Shifting the paradigm of fraud detection
Management Faculty Research
  • David P. Paul, III
  • Sarah Clemente
  • Ronald McGrady
  • Rob Repass
  • Alberto Coustasse, Marshall University
Document Type
Article
Publication Date
10-1-2016
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.
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Paper presented at Academy of Business Research Fall 2016 Conference, Atlantic City, NJ. Copyright © 2016 The Authors. All rights reserved.

Citation Information
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.