Startup Guides > Common Examples of Medicare, Medicaid Fraud

Medical fraud is the intentional deception or misrepresentation of healthcare transactions by the provider for the sake of receiving unauthorized benefits or financial gain. Healthcare fraud is committed when a dishonest provider intentionally submits, or causes someone else to submit, false or misleading information for use in determining the amount of healthcare benefits payable by an insurer. Many leading, medical groups calculate fraud to amount up to 10% of all healthcare costs.

Most healthcare fraud today is being committed against Medicare and Medicaid, both funded with U.S tax payer dollars. Medicare pays out over $800 billion a year for claims. Medicaid also has enormous budget, providing $615 billion a year. Their sheer size makes these goliaths a target for those groups committing fraud. Plus with such volume, the U.S. Government is unable to police fraudulent claims. They rely on whistleblower. However, a ton, if not most goes undetected.