The issues of fraud and fraudulent billings continue to dominate national and local headlines. The state lost its federal Medicaid fraud unit funding for not aggressively pursuing falsified billings. Local officials were bribed to steer contracts to a sole-source contractor. The state is bilked out of millions of dollars by its homeless housing contractor.
The common thread to all these stories is clear – acts of unbridled greed by individuals and corporations whose sole purpose is to maximize profit at the public’s expense. Government contracts and government funding are the sweet spot for fraudulent billing. Lax oversight, coupled with hidden cost over-runs and false claims for payment, make it easy for these unscrupulous actors to avoid detection.
The total amount of fraudulent billing to programs like Medicare and Medicaid is unknown. Reasonable estimates are that five to ten percent of all billings are fraudulent. That would amount to as much as $120 billion nationally for Medicare and $95 billion nationally for Medicaid falsely billed each year. Locally, the estimates are equally staggering – as much as $540 million for Medicare and $320 million for Medicaid falsely billed each year.
How can we be protected from this theft and what actions should state and local governments take to combat the fraud?
The answer is the State False Claims Act and the County False Claims Act — state statutes that allow private parties to bring actions on behalf of the government with...
The issues of fraud and fraudulent billings continue to dominate national and local headlines. The state lost its federal Medicaid fraud unit funding for not aggressively pursuing falsified billin...