Medicaid Anti-Fraud Efforts Paying Off

There have been many stories lately about the tremendous toll Medicaid fraud takes on agency resources. A small fraction of healthcare providers engaged in fraud are responsible for a large financial drain on public funds.

Catching specific incidents of fraud is difficult, however, because Medicaid is an enormous, complex healthcare program that works as a state/federal partnership. Stateline reports that the Medicaid system services approximately 60 million low-income people, and the program costs over $400 billion each year. In addition, Medicaid programs have been the fastest growing items on states’ budgets.

Regulators must balance catching those making fraudulent Medicaid claims against overburdening healthcare providers so that doctors, dentists, and other healthcare providers become unwilling to treat Medicaid recipients.

States are developing new ways of going after those involved in Medicaid fraud. If these anti-fraud tools become increasingly effective, as regulators hope, they could allow states to provide care to those who need and deserve it while spending less in Medicaid reimbursements overall.

Medicaid Fraud Control Units are separate entities from the Medicaid programs themselves. They focus on prosecuting those committing fraud and recovering money paid out by Medicaid on false claims. The fraud control units are able to recover significant funds while controlling expenses. Perhaps because of the growth of these fraud control units, the percentage of Medicaid funds paid on false claims has dropped from 11 percent in 2008 to 8 percent in 2011. Still too much money is spent on false claims from unscrupulous providers, but the improvement is significant.

Waters & Kraus is a national firm with highly skilled lawyers practicing qui tam litigation in four offices, including Dallas, Los Angeles, San Francisco, and Baltimore. Our attorneys have decades of experience successfully representing whistleblowers in a variety of fraud cases. Contact us or call our attorneys at 800.226.9880 to learn more about our practice and how we can assist.

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