The Trump Administration has launched a novel attack on Medicaid accusing blue state Attorneys General (AGs) of not cracking down on fraud — and using that as an excuse to cut funding for New York State’s Medicaid fraud agency, which has a strong record of stopping fraud.
To be clear, allegations of Medicaid fraud do not claim that individual Medicaid beneficiaries have cheated the government and enriched themselves. States have in place rigorous protocols for verifying the eligibility of individuals for enrollment in their Medicaid programs. While an individual who is not eligible may occasionally slip through and receive health care that they are not entitled to, this is fairly rare and does not result in cash payments to the individual.
The real Medicaid fraudsters are insurance companies whose Medicaid Managed Care Organizations (MCOs) overbill the Medicaid program, cheating states and the federal government to enhance corporate profits. And they are vendors and service providers that hatch schemes to falsely bill Medicaid to line their own profits. And by all available evidence, state Attorneys General – most notably New York’s – have successfully pursued these cases, returning billions in recovered funds to the Medicaid program.
This type of corporate fraud is well-documented. Centene Corporation, the insurance company that is the largest provider of Medicaid MCOs by number of Medicaid recipients enrolled, has settled with at least 20 states that accused it of...
The Trump Administration has launched a novel attack on Medicaid accusing blue state Attorneys General (AGs) of not cracking down on fraud — and using that as an excuse to cut funding for New York...