The amount of money flowing through the Medicare and Medicaid pots is a tempting target for criminals. For example, it is estimated that in 2007 approximately $23.7 billion was paid out improperly from both Medicare and Medicaid, with $12.9 billion of that coming from Medicaid. Given that the United States’ senior population, which is comprised of people 65-and-over, is expected to double over the next 38 years, it is likely that the amount of funds obtained through fraudulent means will only continue to increase.
So how are these funds being obtained? From 2000-2007, up to $92,000,000 was paid out to dead physicians from the government’s coffers. As if that’s not alarming enough, these claims were supposedly filed by over 16,500 deceased physicians. Additionally, almost one-third of the monies paid out for durable medical equipment claims in 2006 were done so in error.
Of course, not all of the news is bad regarding Medicaid and Medicare fraud. According to a report from the consumer group Public Citizen, the Federal and state governments have recovered an estimated $6.6 billion in Medicaid fraud case settlements during the first half of 2012. Expanding that to a little less than a two year time period, between 2010 and 2012, $10.2 billion was recovered by the government from fraud settlement cases; although, the majority of that money came from settlements reached with some of the nation’s largest pharmaceutical companies.
The fight against Medicaid fraud is not a losing battle. For every $1.00 the U.S. government spends on combating such fraud, it saves $1.55, and almost 17 states have, at the very least, recovered the costs expended on fraud enforcement efforts.