First a brief description covering the difference between Medicare
and Medicaid. Medicare is for the old and disabled, regardless of
income. Medicaid is for the poor. Medicare has its rates set by the
Feds and is paid directly out of Federal coffers. Medicaid also has
its rates set by the Feds, but the payments come from the States (or
from cities, with States making a contribution.)
If a Doctor is defrauding the system, he's usually doing it one of
- He really sees the patient and provides a service...but
he bills for a higher level of service or more services than
he actually delivered.
- He invents patients and bills for service that never was
- Kickback schemes.
Sometimes it is the patient defrauding the system...and the doctor
knows nothing about it. The most common occurrence is when someone
with coverage (and a card) lends his card to somebody else and that
somebody else gets treated.
No matter what the fraud, however, these benefits are paid out of
Federal or State budgets, and THOSE are funded by taxes.
Who pays the taxes? YOU DO.