Needs to be about 2 pgs. With references.
I. Challenges and Problems Associated with Fraud and Abuse in Managed Care
Fraud and abuse in managed care is not without any challenges and problems.
A. Overbilling
1. Patients are billed for services not performed.
on them.
2. Patients are falsely billed for higher-priced.
treatment, also known as "upcoding". Patients'
diagnostic results are inflated to show a more
serious medical condition that it really is
B. Falsification of patients' tests to justify diagnostic results, medical procedures, or surgery that are not required