U.S. flag

An official website of the United States government, Department of Justice.

NCJRS Virtual Library

The Virtual Library houses over 235,000 criminal justice resources, including all known OJP works.
Click here to search the NCJRS Virtual Library

Medicare-Medicaid Anti-Fraud and Abuse Amendments: Their Impact on the Present Health Care System

NCJ Number
Emory Law Journal Volume: 36 Issue: 2 Dated: (Spring 1987) Pages: 691-754
T N McDowell
Date Published
64 pages
Fraud and abuse in the Medicare and Medicaid systems continue to be problems requiring government intervention, but the 1977 amendments to the Federal law are generally ineffective as applied to the current health care system.
These amendments were not drafted in anticipation of the new competitive dynamics of the health care system that emerged in the 1980's. The implementation of Medicare's prospective payment system in 1983 resulted in the development by health care institutions and providers of new strategies and organizational forms. Some of these competitive business arrangements technically conflict with the fraud and abuse provisions of the law. For example, physician recruitment programs, physician incentive plans, shared service agreements, and other practices have all been challenged as violations of the broad language of the fraud statutes. This conflict results in uncertainty in the health care industry, making effective planning difficult or impossible. Repealing the fraud provision would be the most forceful way of alleviating the current uncertainty. More moderate and likely strategies would be to give the U.S. Department of Health and Human Services the authority to once again issue advisory opinions, to revise the fraud statutes extensively, and to make remedial amendments to specific provisions. 364 footnotes. (Author summary modified)


No download available