Medicaid Fraud Takes Center Stage


No one’s in favor of fraud, and that goes double when it impacts a federal program that’s expected to spend $588 billion by 2025. Lawmakers took a critical look at Medicaid fraud oversight at a recent hearing and said the program’s fraud, waste, and abuse is a growing problem. 

Medicaid paid out $37 billion in fiscal year 2017, an increase of 157 percent since 2013, Sen. Ron Johnson (R-Wisc.), said at the Senate Homeland Security and Governmental Affairs hearing. Johnson, who chairs the committee, said he was worried that Medicaid is growing at an unsustainable rate and lacks the controls to detect and mitigate fraud, waste, and abuse. 

Johnson’s condemnation of Medicaid anti-fraud efforts was echoed by Ranking Member Claire McCaskill (D-Mo.), who said the level of Medicaid improper payments was “outrageous”. 

The hearing followed on the heels of a report from Republican committee members that include a number of recommendations designed to improve Medicaid’s approach to fraud, waste, and abuse. For example, the report said Medicaid should immediately implement 11 recommendations made by the Government Accountability Office, such as reviewing Medicaid eligibility determinations and improving anti-fraud education. 

Some of the report’s findings were addressed by a new Medicaid anti-fraud strategy that was rolled out the day before the hearing. The strategy calls for new audits to assess how the states are determining who’s eligible for Medicaid benefits, as well as some targeted audits of Medicaid managed care organizations.

The Centers for Medicare & Medicaid Services Adminstrator Seema Verma was asked to testify at the Senate hearing but declined due to scheduling issues. Johnson said he recently spoke with Verma and said she was open to testifying at future hearings. 

Read my story here.

Stay on top of new developments in health law and regulation, and learn more, by signing up for a free trial to Bloomberg Law.