Medicaid Fraud in America: Uncovering Wasteful Spending in Healthcare
In 2012, the State of South Carolina spent $4.8 billion on the Medicaid program. At the end of that fiscal year, the US Department of Health and Human Services Office of Inspector General reported that nationwide only $1.4 billion had been recovered in fraudulent cases. “The US spends more than $2 trillion on healthcare annually. At least 3% of that spending-or $68 billion-is lost to fraud each year. Fraud accounts for 19 percent of the $600 billion to $800 billion in wasteful spending in the US healthcare system annually.” (Office of Inspector) No wonder our nation is in an economic breakdown in the health insurance market. The solution to Medicaid fraud may be as simple as spending more money on investigations and less time approving those who are just too lazy to work.
“Medicaid fraud occurs when a Medicaid provider knowingly makes a false or misleading statement or representation for use in obtaining reimbursement from the Medicaid program”. (Medicaid Fraud) Medicaid fraud is nothing new to South Carolina. There has been Medicaid fraud since the start of the Medicaid program on July 30th 1965. All across the state, in every hospital and doctor’s office, patients are being seen using Medicaid insurance cards that have no right to be using these cards. It’s everywhere, and these people have gotten on the program by filling out their paperwork incorrectly and turning it into the correct government office with all the check marks in the right places. The problem is, some of these people are not sick and are perfectly able to work, just don’t wish to do so. Let’s make it fair and only put the people that need to be on Medicaid on Medicaid and quit paying for the lazy to go from hospital to hospital when they have a common cold.
“The Medicaid program provides health benefits to low-income families who either have no medical insurance or have inadequate medical insurance. The federal government establishes the general Medicaid guidelines; however the program requirements are established and monitored by each individual state.” (How to Report) Very few people here in our county probably know where to go to be able to report someone who is guilty of fraud. Our Federal government has programs out there, we just need to be able to use them. These offices should be brought more to light than what they currently are. Each state is responsible for the monitoring of their Medicaid program. We the people need to know where we need to go or who we need to contact to be able to share our concerns with our governmental healthcare leaders. There are several benefits to uncovering Medicaid fraud in our local area. One of the best benefits is that it will provide more money for the people in our community who currently need to be on Medicaid but can’t get on it due to extreme budget cuts. Not only will it allow help for people who need it, but it will also provide jobs within our state. “In 2010, fraud bureaus employed more than 1,400 people, including nearly 900 investigators.” (Fraud Statistics) Aside from creating jobs, it would make our system more stable and would allow our elderly and disabled an opportunity to receive the treatments in which they need to be able to survive. This would allow our family and friends to live longer and be healthier when they get older instead of struggling the last few days of their life.
The down side to having this kind of watch over our Medicaid system is that we have to pay the bill for this. Currently, there is very little investigation into someone applying for the Medicaid system and it is very quick to get on it. Medicaid can now even be applied for online and approved in just a few minutes without even having to leave the comfort of your home. “You qualify for these programs based on your household size, income, and other factors, like age and disability. When you...
Cited: Fraud Statistics. Coalition against Insurance Fraud, n.d. Web. 12 Nov. 2014.
How to Qualify for Medicaid. Healthcare.gov, n.d. Web. 13 Nov. 2014.
How to Report Fraud. cms.gov, n.d. Web. 13 Nov. 2014.
Please join StudyMode to read the full document