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If this $100B number were accurate I would expect a certain group of politicians to jump on it. The total Medicaid spend in 2021 was $734B . So that would mean

If this $100B number were accurate I would expect a certain group of politicians to jump on it. The total Medicaid spend in 2021 was $734B . So that would mean 14% of Medicaid payments are fraud. This would mean you could simply take ~100 Medicaid bills at random from the whole country and have an agent go follow the money in detail and 14% of the time they would end up arresting someone ? Seems like this could easily self fund more agents if the numbers are true. Source: https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nhe-fact-sheet https://www.cms.gov/research-statistics-data-and-systems/sta...

lostmsu 4y ago
> I would expect a certain group of politicians to jump on it Is discourse here so bad the Republican party can't be named?
- kevingadd 4y ago
  With how aggressively they de -fang the IRS so it can't enforce white collar crime, it doesn't seem a given that they would want to spend tax dollars investigating and prosecuting this kind of white collar crime. They're more likely to just get rid of Medicare to cut costs.
  - WalterBright 4y ago
    As economist C Northcote Parkinson wrote, once taxes become high enough tax evasion inevitably becomes the national sport.
htag 4y ago
> The total Medicaid spend in 2021 was $734B . So that would mean 14% of Medicaid payments are fraud. The report indicates that the $100B/yr is between Medicaid and Medicare, which has a total spend of ~$1.6T, or roughly 6% are fraud.
lostlogin 4y ago
A similar line of thought applied to white collar crime and blue collar crime (eg tax fraud and social benefit fraud) also nets a similar conclusion. Why aren’t white collar crimes chased harder? https://www.wgtn.ac.nz/news/2017/08/why-is-tax-evasion-treated-more-gently-than-benefit-fraud2 https://www.wgtn.ac.nz/news/2017/08/why-is-tax-evasion-treat...
ThinkingGuy 4y ago
There are plenty of politicians who would like to take action to address the issue of Medicare and Medicaid fraud. The problem is, there's an equally influential group of politicians who prefer to use it for political purposes instead: "See? This proves how inefficient the government is at providing healthcare! Let's cut their funding and let corporations take over instead!"
- jeffbee 4y ago
  Right, some want to cut out the middleman by paying Medicare money directly to the fraudsters.
hattmall 4y ago
I'm sure it's far higher than that percent. But it's questionable on how you define fraud. For example, is it fraud for an Ambulance service to pay $100 to a taxi for a referral to transport a someone on medicaid / medicare if their trip has any inkling of a medical reason. Is it fraud for transport companies to take people wherever they want to go so long as they make some type of medical stop (grocery store with pharmacy) at some point during the trip. Is it fraud to blanket an area with signs saying "Cash for Diabetic Testing Strips" then go around door to door and sell (bill medicaid) testing strips to Medicaid recipients? Is it fraud that multiple FedEx trucks are needed every day to drop off "Mom's meals" which never get picked up in the lobby of any given senior apartment building? I'm sure there's lots of examples of obvious outright fraud where things are never done or delivered, but there's orders of magnitude more scams that aren't clearly illegal. Half of my high school class seems to have some sort of scam that involves billing the government. There are multiple people that have "Medical transport companies" they go to the USVI and recruit drivers then buy some shitty minivan and slap a large magnetic sticker on it and offer free rides so long as you do something vaguely medical.
- costco 4y ago
  > Is it fraud to blanket an area with signs saying "Cash for Diabetic Testing Strips" then go around door to door and sell (bill medicaid) testing strips to Medicaid recipients? I saw one of these and was sort of confused (if you're diabetic don't you need the test strips?) but apparently this is legal and happens everywhere! It seems it isn't legal for pills because it's considered "misbranding" and there are some storage requirements but when I read about cases of that it sounded even more alarming. People with HIV selling expensive HIV medicines they got for free for $20.
tssva 4y ago
The $100B number given is across Medicaid and Medicare together. Medicare spend in 2021 was around $901B so the total would be $1.635 trillion. This means around 6% of the total spend was fraud not 14%. It would be interesting to see the estimated fraud for each program. The examples in the article were Medicare fraud and not Medicaid. Medicare directly pays providers but Medicaid is provided through block grants from the federal government to the states. The individual states administrator the Medicaid programs within their state. Some states direct pay providers as Medicare does and some work almost entirely through private insurance plans which Medicaid funds cover the premiums for. Because of this the level of Medicaid fraud likely varies much more between states than it does for Medicare.
naijaboiler 4y ago
if you randomly take 100, you wouldn't find 1 in 7 to be fraudulent. Fraud is not uniformly distributed. It is clustered mostly clustered around a few individuals. for the rest, if you look long enough, yeah you will likely find something fraudulent, but there's no way to find and fix those minor ones without harming real honest folks. But the fraudulent clusters, yeah those are worth identiifying.

lostmsu 4y ago

> I would expect a certain group of politicians to jump on it Is discourse here so bad the Republican party can't be named?

kevingadd 4y ago
With how aggressively they de -fang the IRS so it can't enforce white collar crime, it doesn't seem a given that they would want to spend tax dollars investigating and prosecuting this kind of white collar crime. They're more likely to just get rid of Medicare to cut costs.
- WalterBright 4y ago
  As economist C Northcote Parkinson wrote, once taxes become high enough tax evasion inevitably becomes the national sport.

htag 4y ago

> The total Medicaid spend in 2021 was $734B . So that would mean 14% of Medicaid payments are fraud. The report indicates that the $100B/yr is between Medicaid and Medicare, which has a total spend of ~$1.6T, or roughly 6% are fraud.

lostlogin 4y ago

A similar line of thought applied to white collar crime and blue collar crime (eg tax fraud and social benefit fraud) also nets a similar conclusion. Why aren’t white collar crimes chased harder? https://www.wgtn.ac.nz/news/2017/08/why-is-tax-evasion-treated-more-gently-than-benefit-fraud2 https://www.wgtn.ac.nz/news/2017/08/why-is-tax-evasion-treat...

ThinkingGuy 4y ago

There are plenty of politicians who would like to take action to address the issue of Medicare and Medicaid fraud. The problem is, there's an equally influential group of politicians who prefer to use it for political purposes instead: "See? This proves how inefficient the government is at providing healthcare! Let's cut their funding and let corporations take over instead!"

jeffbee 4y ago
Right, some want to cut out the middleman by paying Medicare money directly to the fraudsters.

hattmall 4y ago

I'm sure it's far higher than that percent. But it's questionable on how you define fraud. For example, is it fraud for an Ambulance service to pay $100 to a taxi for a referral to transport a someone on medicaid / medicare if their trip has any inkling of a medical reason. Is it fraud for transport companies to take people wherever they want to go so long as they make some type of medical stop (grocery store with pharmacy) at some point during the trip. Is it fraud to blanket an area with signs saying "Cash for Diabetic Testing Strips" then go around door to door and sell (bill medicaid) testing strips to Medicaid recipients? Is it fraud that multiple FedEx trucks are needed every day to drop off "Mom's meals" which never get picked up in the lobby of any given senior apartment building? I'm sure there's lots of examples of obvious outright fraud where things are never done or delivered, but there's orders of magnitude more scams that aren't clearly illegal. Half of my high school class seems to have some sort of scam that involves billing the government. There are multiple people that have "Medical transport companies" they go to the USVI and recruit drivers then buy some shitty minivan and slap a large magnetic sticker on it and offer free rides so long as you do something vaguely medical.

costco 4y ago
> Is it fraud to blanket an area with signs saying "Cash for Diabetic Testing Strips" then go around door to door and sell (bill medicaid) testing strips to Medicaid recipients? I saw one of these and was sort of confused (if you're diabetic don't you need the test strips?) but apparently this is legal and happens everywhere! It seems it isn't legal for pills because it's considered "misbranding" and there are some storage requirements but when I read about cases of that it sounded even more alarming. People with HIV selling expensive HIV medicines they got for free for $20.

tssva 4y ago

The $100B number given is across Medicaid and Medicare together. Medicare spend in 2021 was around $901B so the total would be $1.635 trillion. This means around 6% of the total spend was fraud not 14%. It would be interesting to see the estimated fraud for each program. The examples in the article were Medicare fraud and not Medicaid. Medicare directly pays providers but Medicaid is provided through block grants from the federal government to the states. The individual states administrator the Medicaid programs within their state. Some states direct pay providers as Medicare does and some work almost entirely through private insurance plans which Medicaid funds cover the premiums for. Because of this the level of Medicaid fraud likely varies much more between states than it does for Medicare.

naijaboiler 4y ago

if you randomly take 100, you wouldn't find 1 in 7 to be fraudulent. Fraud is not uniformly distributed. It is clustered mostly clustered around a few individuals. for the rest, if you look long enough, yeah you will likely find something fraudulent, but there's no way to find and fix those minor ones without harming real honest folks. But the fraudulent clusters, yeah those are worth identiifying.