In the past:
When the OIG did audits on fraud for Medicare Advantage for the past several years, the literal definition of fraud in their reviews was to have a code in the RAPS payment system that was not the one in the actual medical record of the patient… [and] they estimated in a couple of reports that the fraud level using that definition … would be as much as 6 percent of the total Medicare Advantage spend.
The fee-for-service Medicare fraud level ranges from 6–7 percent, so the people looking at both numbers said that the plans and the caregivers were in the same ball park….