Medicare Advantage/ Medicare+Choice Program: Part CThe Balanced Budget Act of 1997 created Part C to allow individuals to choose private plans as alternatives to Parts A and B. I Private plans must include at least all services offered in Parts A and B and may include a reduction in cost sharing or premiums. Part C is paid from the HI Trust Fund and the Part B SMI Trust Fund and is proportional to the amount of benefits paid by Parts A and B. Administrative costs for Part C were 1.4% in 2008 Beneficiary payments vary by plan, and are based on capitation; beneficiaries pay a fixed monthly amount regardless of the services actually used (Klees et al., 2009). FraudMedicare is susceptible to fraud due to its size and complicated structure. Frauds range from accidental errors in statement accuracy to intentional billing abuse. Suppliers are expected to make truthful claims, which are then checked by the affiliated intermediaries who supervise the payment. Quality Improvement Organizations (QIOs), Medicare Integrity Programs (MIPs), and the Department of Justice (DOJ) are some of the many groups charged with preventing and recovering fraudulent payments. QIOs are “groups of health care professionals who are paid by the federal government to improve the effectiveness, efficiency, economics, and quality of services provided to Medicare beneficiaries” (Klees et al., 2009, p. 16) Among the responsibilities of QIOs is to ensure “that Medicare pays only for services and items that are reasonable and necessary and are provided in the most appropriate context” (Klees, 2009, p. 14). in 1996 under the Health Insurance Portability and Accountability Act (HIPAA). $40 billion in federal funding was awarded through 2007. Another $10 billion was spent in 2008, and in 2009 federal funding was extended through 2013. States were also given the option to provide coverage through expansion of their Medicaid programs. The federal government pays an “enhanced” FMAP, averaging 71.36% in 2009, for CHIP (Klees et al., 2009). PACE is a state option created by the Balanced Budget Act to provide nursing facility-level care to people age 55 and older. alternative to institutionalization. Participating providers are paid exclusively through PACE and are required to provide all services included in Medicare and Medicaid coverage regardless of the actual duration or extent of the services. Providers cannot charge additional deductibles, copays, or other fees to beneficiaries (Klees et al., 2009).