Final answer:
The question discusses the complications with Medicare billing guidelines and how providers accidentally submitted claims for services not covered by Medicare. It also touches on the broader issues such as coverage 'gaps', price inflations and fraud within low-income neighborhoods.
Step-by-step explanation:
The question pertains to Medicare billing guidelines and the issues faced when health care providers inadvertently submit claims for services not covered by Medicare. Initially, Medicare provided benefits to many, but it did not cover expenses such as prescription drugs. This led to criticisms regarding coverage 'gaps'. Providers, paid primarily by insurance companies and the government, began to substantially raise prices. This price inflation was unlike the free market, where consumers often seek the best prices because they pay directly.
Once Medicaid began covering emergency care costs, there was an increase in emergency room visits by low-income individuals who previously went without due to costs. Furthermore, instances of fraud emerged, where unnecessary and expensive tests were performed on Medicaid clients by a few clinics that were established in poorer neighborhoods. These instances underscore the complexities and unintended consequences of the Medicare system's billing and coverage guidelines.