Fraud and abuse are significant problems affecting costs in the health care system. They come in many forms.
Federal antitrust laws protect open competition in economic markets. Antitrust laws reflect
A loophole in Medicare law related to hospital outpatient services (such as diagnostic tests, radiology, and certain surgeries) had subjected beneficiaries to much higher c
Traditional fee-for-service Medicare uses several payment systems to pay providers for services in the traditional program: prospective, episode-based, and
Medicare pays for hospital inpatient and outpatient services using a prospective payment system (PPS).
Medicare sets payment rates for physician services according to a fee schedule.
Under Part B, Medicare covers many types of medically necessary assistive technologies that improve health and functioning, including durable medical equip
Postacute care under Medicare refers to services provided after inpatient hospitalization or outpatient treatment.
Ensure adequacy and affordability—Medicaid should remain a v
Under the current Medicaid financing system, federal Medicaid funding increases in response to increases in enrollment, service costs, and service use.