Medicare Fraud Case Study

Emily, I also believe that providers can establish a reasonable expectation as to how Medicare will act. Medicare bundles billings for a reason, and there is a set fee schedule for a reason, so for providers to assume that individual billing of procedures or testing is acceptable to me seems unreasonable and bundling helps to assure that Medicare is not being taken advantage of by providers. As our textbook states, the “Total national health expenditures are expected to continue to rise and to reach about $4.5 trillion per year by 2020….Because the government is such a large purchaser of healthcare services, it is an obvious target for fraud” ((Pratt, 2016, p. 523). It is evident why Medicare reacts in the manner that it did in this court case