Medicaid Fraud Continues to Plague System
With state budgets increasingly tight and Medicaid set to expand drastically in 2014, many lawmakers
are looking for ways to decrease the impact Medicaid has on state budgets. One of the possible
avenues some lawmakers are considering is further decreasing the extent to which Medicaid fraud
impacts the joint federal and state program.
Medicaid currently costs about $400 billion per year to provide healthcare coverage to low income
people, single mothers, the elderly, and those with disabilities. Under the affordable care act, millions
more will be able to apply for Medicaid because the law requires states to provide coverage to anyone
who meets specific income guidelines.
Medicaid fraud accounts for a significant amount of the money spent on Medicaid each year. The
federal government estimates that it lost $22 billion to fraud in 2011, while states probably lost
comparable amounts. As a total of the amount spent on Medicaid each year, it's estimated that about
8% of all payments were lost to fraud in 2011, even though that's down from 11% in 2008.
One of the reasons it's so difficult to combat Medicaid fraud is that each state has its own system and
its own methods. This makes it very difficult to apply a uniform set of fraud prevention practices.
However, as more people are set to receive Medicaid coverage beginning in 2014 and states are under
increased pressure to trim Medicaid budgets, fraud prevention is becoming increasingly more
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