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Report: $14.4 Billion In Fraudulent Medicaid Payments Last Year

Updated: Apr 13

A new report from the Government Accountability Office reveals that federal taxpayers financed $14.4 billion in “improper payments” last year — and who knows how much state taxpayers pitched in:

In fiscal year 2013, the Medicaid program covered about 71.7 million individuals at a cost of $431.1 billion, of which CMS estimated that $14.4 billion (5.8 percent) were improper payments.

GAO says the program is so big and “diverse,” it’s tough to monitor fraud. Some of this fraud includes violation of Medicaid rules and billing for services that were never provided:

The size and diversity of the Medicaid program make it particularly vulnerable to improper payments—including payments made for treatments or services that were not covered by program rules, that were not medically necessary, or that were billed for but never provided.

Finally, GAO said (unsurprisingly) the problem could get worse under Obamacare in coming years:

Improving federal and state efforts to strengthen Medicaid managed care program integrity takes on greater urgency as states that choose to expand their Medicaid programs under the Patient Protection and Affordable Care Act are likely to do so with managed care arrangements, and will receive a 100 percent federal match for newly eligible individuals from 2014 through 2016. Unless CMS takes a larger role in holding states accountable, and provides guidance and support to states to ensure adequate program integrity efforts in Medicaid managed care, the gap between state and federal efforts to monitor managed care program integrity will leave a growing portion of federal Medicaid dollars vulnerable to improper payments.

And the problems are getting worse: the state of Arkansas recently revealed that 5,000 Arkansans were improperly enrolled in the state’s Medicaid expansion program. Numerous other states are also experiencing fraud problems under Obamacare. Meanwhile, the national debt clock continues to tick. It’s now at over $17.5 trillion.

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