Fraud and Abuse: Medicare Continues to Be Vulnerable to Exploitation by Unscrupulous Providers

GAO discussed challenges Medicare faces in battling fraud and abuse in the health care system, focusing on reasons that: (1) Medicare is an appealing target for unscrupulous providers; and (2) abusive practices persist despite efforts by program managers and law enforcement agencies. GAO noted that: (1) although most Medicare providers abide by program rules, Medicare has difficulty preventing fraudulent and abusive practices; (2) some unscrupulous providers such as home health agencies, pharmacists, and medical suppliers are attracted by high reimbursement rates for some supplies and services and the few barriers to entry into the Medicare marketplace; (3) exploitative providers often escape detection because of inadequate claims oversight, insufficient resources, and fragmented authority responsibilities; and (4) those providers convicted of fraud face minimal sanctions.