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Editor's Note
October 28, 2019

The Human Costs of Medicare Fraud and Abuse

Author Affiliations
  • 1Section of General Internal Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
  • 2Associate Editor, JAMA Internal Medicine
JAMA Intern Med. Published online October 28, 2019. doi:https://doi.org/10.1001/jamainternmed.2019.5004

The Centers for Medicare & Medicaid Services define Medicare fraud as knowingly submitting false claims to improperly obtain federal health care payments, as well as knowingly soliciting, receiving, offering, or paying remuneration (eg, kickbacks, bribes, or rebates) to induce or reward referrals for items or services that are eligible for reimbursement by federal health care programs.1 Medicare abuse is defined as practices that may directly or indirectly result in unnecessary costs to the Medicare program, including providing patients with medically unnecessary services, as well as fraudulent billing practices such as upcoding.1 These activities are both illegal and unethical, costing the Medicare program, and thus the broader public, billions of dollars annually. To date, attention to these activities has been driven predominantly by the financial losses incurred.

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