Do managed care organizations do enough to combat Medicaid fraud? The question means more than in the past for North Carolina, which is preparing to rely more on private insurers for Medicaid administration. The US Department of Health and Human Services Inspector General (OIG) found Medicaid managed care organizations lax in their fraud detection and reporting efforts.
Medicaid fraud costs taxpayers billions of dollars each year. According to a 2017 PBS NewsHour report,
Fraud, overpayments and underpayments in all assistance programs cost federal and state governments about $136.7 billion in 2015, out of about $2.8 trillion spent in assistance overall….On average, about 4.8 percent of assistance payments by federal and state government agencies were made in error in 2015, according to a 2016 GAO report. The error rate for SNAP was estimated at about 3.7 percent and for Medicaid at about 9.8 percent.
The OIG report began under the Obama administration and Seema Verma, who heads Medicaid and Medicare for the Trump administration, supported the recommendations.
