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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 aroun
by 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.