Investigative Group

Feds Have No Idea What Medicare, Medicaid Fraud Costs

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Don’t ask the top congressional watchdog how many tax dollars are lost each year to Medicare and Medicaid fraud.

“It would be really nice to know how much fraud there is in Medicare and in other healthcare programs,” Government Accountability Office Health Care Director Kathleen King said in a WatchBlog podcast Wednesday. The GAO is Congress’ chief oversight investigative tool for monitoring executive branch spending and management.

“Part of the reason that we don’t have a reliable estimate at this point is because providers could do things that look legitimate on their face,” she said.

A properly enrolled Medicare provider, for example, could submit a “claim that looks perfectly legitimate,” but bills for services that were either never provided or were more complex than the actual service, King said, which is “very difficult to catch.”

Providers billing for services that had not been rendered is the most frequent form of healthcare fraud and accounts for 42 percent of convictions or judgements, according to King.

“Fraudsters can hide among the program’s 100 million beneficiaries, countless providers, and more than $1 trillion in annual spending,” the podcast’s narrator says. “But little is known about the who and how of these fraud schemes.”

King added: “I don’t think there’s any one single answer that would stop all of the fraud in healthcare.”

The Medicaid Fraud Control Units nationwide recovered nearly $745 million in 2015, according to the Department of Health and Human Services inspector general.

The federal government spends more than $845 billion on Medicare and Medicaid annually.