Medicaid fraud a $30 billion industry

Want to make some easy cash? Try defrauding Medicaid.

It’s a booming business, according to the federal Centers for Medicare & Medicaid Services, which says the total amount of “improper payments” for Medicaid last year totaled more than $29 billion and accounted for nearly a tenth of all payments. Just one caveat: you’ll probably get caught, and you may serve some prison time.

This illicit industry – along with other kinds of costly health care waste – is the subject of a new report released last week by the Illinois Health Care Fraud Elimination Task Force. Created by Gov. Bruce Rauner in April, the panel hopes to battle fraud, waste and abuse in Medicaid, state employee health insurance and workers’ compensation cases. The surprising thing is, however, that the vast majority of fraud in government-funded health care programs isn’t perpetrated by patients; it’s done by doctors, nurses, pharmacists and other medical providers.

Source: Medicaid fraud a $30 billion industry ILLINOIS TIMES

One Response

  • “…the vast majority of fraud in government-funded health care programs isn’t perpetrated by patients; it’s done by doctors, nurses, pharmacists and other medical providers.”

    That might have been the case 20 years ago but I believe the majority of Medicaid fraud today is perpetuated by the state employees and elected officials that are legislating to bring managed care into the equation by promoting capitation. The losers in that situation are the patients and yes even the providers. MCNA has been looking for ways to not pay providers for treatment legitimately needed and rendered since they were brought to Texas in March of 2012, hence the Main Dental Home initiative. They wanted every child to have a main dental home and every time we turn around they are changing the patient’s main dental home. Interesting thing is that the providers WILL NOT be paid if they do not catch that the patient’s “assigned provider” has been changed before they have seen the patient. NO EXCEPTIONS. Even if the treatment was an emergency. NO EXCEPTIONS. That is the greatest loophole of all times to keep a Managed Care Organization from having to pay for treatment rendered. In addition, common sense tells us it is never a good sign when former state employees including executives and the State Dental Director and even our former Governor goes to work for a company that they created a position for in the state, namely MCNA.

    Now that would be a productive investigation.

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