Tag Archives: Medicaid and Medicare fraud

Solving The Medicare Fraud Problem

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On Wednesday, The Daily Signal posted an article about the next steps in dealing with home health care fraud.

The article reports:JD

The Centers for Medicare & Medicaid Services is pausing new Medicare enrollment for hospices and home health agencies for six months to review alleged rampant fraud.

Vice President JD Vance’s Anti-Fraud Task Force is working with the agency to combat fraud, waste, and abuse in Medicare. So far, the task force has withheld $1.4 billion in federal funding from home health and hospice providers across the country, Fox News reported.

“We’ve seen systemic and deeply troubling fraud in the hospice and home health space, with bad actors exploiting some of our most vulnerable Medicare patients and stealing money from the American taxpayer,” CMS Administrator Dr. Mehmet Oz said.

“Today we’re shutting the door on fraud—preventing new bad actors from entering Medicare while we aggressively identify, investigate, and remove those already exploiting them. This is about protecting patients, restoring integrity, and safeguarding taxpayer dollars,” Oz said.

The announcement comes after the Daily Wire reported on alleged widespread Medicare fraud in Ohio’s home health industry. Officials with Ohio Medicaid told the Columbus Dispatch the department had been investigating fraud concerns before the recent reports surfaced.

The moratorium will not affect current Medicare enrollments. Existing providers will continue to deliver services to Medicare beneficiaries.

The article concludes:

In February, Vance announced that the administration was withholding reimbursements for $259.5 million in Medicaid funds from Minnesota pending an investigation into allegations of widespread welfare fraud there.

Vance is holding a news conference Wednesday afternoon to warn all 50 states they must fully comply with anti-fraud statutes or risk losing federal Medicaid funding, the Wall Street Journal reported.

“Under President Trump, we are unleashing the most aggressive federal anti-fraud efforts in American history,” Vance said. “We won’t rest until we root out every bit of fraud infecting our government and screwing over taxpayers.”

Getting rid of the fraud in Medicaid and Medicare could easily add years to the life of the programs. It is long past time this was done.

The Reward For Whistleblowers

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On Sunday, The New York Post posted an article about  Treasury Secretary Scott Besent’s idea for encouraging whistleblowers to report fraud.

The article reports:

Uncle Sam needs you to help crush the billion-dollar financial fraud gangs.

Treasury Secretary Scott Bessent is launching a new program on Monday that will reward tipsters with up to 30% of the fines imposed on criminals who are trying to bleed US taxpayers dry, The Post has learned.

The program includes tips for Medicaid and Medicare rip-offs — and given that fraud in those two programs tops some $70 billion per year according to one estimate, whistleblowers could be in for some big payouts.

Other forms of financial crimes are also included.

The payments will come directly from fines, rather than having the American taxpayers foot the bill, according to confidential Treasury documents obtained by The Post.

“Individuals located in the United States or abroad who provide information may be eligible for awards if the information they provide leads to a successful enforcement action that results in monetary penalties exceeding $1,000,000,” one of the documents reads.

It would mirror a similar scheme run by the Internal Revenue Service, which is also overseen by the Treasury Department.

The article notes:

Medicaid and Medicare fraud costs at least an estimated $68.7 billion each year, according to a 2022 study conducted by the Colorado State University Global White Collar Crime Task Force.

Illustration of the "Operation Gold Rush" scheme showing a transnational criminal organization defrauding Medicare in the US and laundering money through Russia and other countries.
The Justice Department has alleged that $10 billion in fraudulent claims were filed while transnational criminal organizations received $941 million from Medicare and Medicaid supplemental insurers. DOJ

The confidential Treasury warning to banks raises as many as 24 “red flags” for financial institutions to watch for, including claims logged by someone without permanent residence in the US, sudden spikes in billing from newly established medical companies, or making huge transfers to companies overseas just after a direct deposit from the government clears.

The article concludes:

Treasury hit New York-based investment bank Canaccord Genuity with a record $80 million civil fine just three weeks ago for failing to monitor suspicious trading.

Investigators said that between 2019 and ⁠2022, Canaccord failed to file at least 160 suspicious activity reports covering thousands of ​questionable transactions, with some activity that deserved “red flags” going unreviewed for months or years.

The allegations were unrelated to healthcare fraud, but focused on a Cyprus-based firm that spent years helping Russian oligarchs move money out of Russia.

The corruption is deep, and it is on both sides of the aisle.