We all know that Medicare and Medicaid fraud and waste is rampant. While many states are getting tougher, what exactly is being done about it? How is the Federal government handling this growing problem? The brunt of identifying and investigating Medicaid fraud is under the purview of each state's Office of the Inspector General (OIG). Increasing proactive efforts for addressing both the prevalence of fraud and recovery of funds is one way states are tackling the problem.

Where Does Medicaid Fraud Occur?

Medicaid fraud and waste occurs across the board, and is not limited to long-term care facilities, adult day care, rehabilitation centers or assisted living centers. Medicaid fraud ranges from criminal neglect to financial abuse and affects every facet of society in a variety of socio-economic levels and demographics.

There is no existing data on county-by-county Medicaid fraud statistics, although Florida's Broward and Miami-Dade counties have a less-than-stellar reputation for being among the worst in the country.[1] Five states top the list for Medicaid fraud recovery:

On the other end of the spectrum, medical providers or services may duplicate orders for supplies or services, or sell supplies given specifically to Medicaid providers to other than Medicaid recipients - for a profit. In addition, falsifying billing statements, repeating billings, ordering unnecessary supplies as well as billing for more time, and kickbacks are some of the most common instances of fraud committed by medical providers.[3]

What's Being Done about Medicaid Fraud?

Law and policy makers around the country were busy in 2011 brainstorming ways to curtail fraud and boost recovery efforts. Last fiscal year (2011) saw nearly $3 billion in health care fraud alone.....

By Denise Stern

Denise Stern is an experienced  freelance writer and editor with a degree in Health

Information Management. She has previous experience in geriatric care and

focuses much of her writing on topics surrounding senior health care.