Tag Archives: Medicaid fraud

Medicaid Fraud Comes To North Carolina

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The North Carolina State Auditor Dave Boliek has been doing an awesome job. According to artificial intelligence (AI), his initiatives have reportedly saved millions in taxpayer dollars. Recently, he has turned  his attention to Medicaid.

On Saturday, AOL posted an article from Fox News. The article reported:

As fraud concerns ramp up across the country, particularly involving Medicaid, North Carolina State Auditor Dave Boliek told Fox News Digital the problem is very real in his state, especially when it comes to autism therapy, an area that has been highly scrutinized in Minnesota.

Boliek is sounding the alarm on potential waste, fraud and abuse within the state’s Medicaid program, specifically noting in an interview with Fox News Digital a 47,000% explosion in autism therapy billings he has flagged since taking office last year. 

“Those are vital services to folks and individuals that need that therapy,” Boliek said. “But when you have, like in North Carolina, a system that went from $1.4 million or so in total billings for autism therapy to more than $660 million a year in billings on autism therapy within a five-year range, that begs an audit from the state auditor, who in North Carolina, we are the top watchdog agency for taxpayer waste, fraud and abuse prevention. So, we’ve dug down into that and are in the middle of that.“

The article concludes:

In terms of next steps in North Carolina, Boliek says his office is working with lawmakers to strengthen fraud enforcement by increasing financial accountability, expanding investigative and Medicaid audit resources and investing in staff and technology to recover misused funds. 

Boliek explained that one important tool to crack down on fraud is artificial intelligence. 

“Look, we’ve got to pour jet fuel on artificial intelligence in the area of state auditing because the fraudsters are using AI and if we’re not using AI to combat the fraud, then we’re going to be on our heels and the taxpayer isn’t going to be protected.”

He emphasized that these steps, especially enhancing oversight of programs like Medicaid, are aimed at holding individuals accountable and returning taxpayer dollars for more effective use. 

The State Financial Officers Foundation, a group of financial officers that collectively oversees more than $3 trillion in state funds, released a report earlier this year outlining how the organization safeguarded more than $28 billion of waste, fraud, and abuse in 2025 alone.

“Every wasted dollar is a dollar that can’t be spent on a person who actually needs service,” Boliek said.

There need to be severe consequences for Medicaid fraud.

Your Tax Dollars At Work

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The level of fraud in government programs is astonishing. Every day we read about another scandal involving the government’s ‘safety net.’ Many of us are wondering how much of our tax dollars are funding fraud rather than a ‘safety net.’

On Wednesday, The Federalist reported:

The ongoing scandal regarding Minnesota’s welfare-industrial complex demonstrates the extent to which government-created graft has “hidden” in front of the nation’s noses for not just years but decades. Another report released just before Christmas illustrates the depths of those fraudulent payments.

Last summer, I wrote here about a report by Louisiana’s legislative auditor highlighting nearly $10 million in Medicaid payments that state made on behalf of deceased beneficiaries between February 2019 and last March. Perhaps unsurprisingly, the most recent report shows that this type of government waste and abuse — or, depending on one’s perspective, fraud by insurance companies, who receive payments for “covering” dead people — occurs with regularity nationwide.

The report came from the Department of Health and Human Services’ Office of Inspector General (OIG) and covered payments made to Medicaid managed care organizations from July 2021 through June 2022. The report arises because in most (but not all) cases, state Medicaid agencies do not directly administer benefits (i.e., pay doctors and hospitals who treat beneficiaries). Instead, they contract with managed care organizations and pay insurers a capitated (i.e., per-person) amount every month for that coverage. That dynamic represents a clear opportunity for fraud: If no one reports the beneficiary as deceased, the insurer will get paid to “cover” that person indefinitely.

The article notes:

A footnote in the report demonstrated how this type of abuse is a choice that states consciously make. OIG noted that “Connecticut, Maine, Mississippi, Nebraska, South Dakota, and Wyoming had no capitation payments with a service date after the month of the enrollee’s death.” In other words, these six states all imposed proper safeguards to ensure that Medicaid dollars did not go to dead beneficiaries, while 35 other states did not, leading to the improper payments. (The remaining states did not have significant amounts of capitated payments to managed care organizations and therefore would not face this type of fraud.)

It’s time for all states to put in place laws that protect taxpayer money. The government should not be paying money to dead people!

One Problem With ObamaCare

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On Monday, The Federalist posted an article about the problem of fraud in the ObamaCare subsidies.

The article reports:

In recent months, these pages have recounted myriad reports of fraud in Medicaid and on the Obamacare Exchanges. The Congressional Budget Office and others have noted millions of potentially erroneous or fraudulent enrollees, who are receiving tens of billions of dollars in taxpayer-funded subsidies.

On Wednesday, the Government Accountability Office (GAO) added to the reports pouring in. Its preliminary analysis raised additional questions about fraud relating to Exchange subsidies, providing yet another reason for Congress not to extend the enhanced Covid-era subsidy regime that expires at the end of the month. 

…During the last plan year, GAO noted that “we either were not requested to provide the federal Marketplace [i.e., Exchange] with documentation or generally did not provide what was requested, yet our four fictitious applicants received subsidized coverage for November and December 2024.” In one example, the federal Exchange sent a letter that “confirmed the applicant’s income based on documentation we submitted,” even though GAO had not sent any such documentation.

This year, GAO said the Exchange “initially approved coverage for 19 of our 20 fictitious applicants,” with the only exception being “when the broker we were working with stopped responding to us.” In another case, the Exchange cut off coverage after the fictitious enrollee did not provide citizenship documentation. But in total, nine months into the plan year in September, “coverage for 18 [of 20] fictitious enrollees remained active,” totaling over $10,000 per month in taxpayer subsidies paid to insurers on behalf of nonexistent enrollees.

One example of fraud:

In 2023, a total of 58,000 Social Security numbers received subsidies yet also matched Social Security Administration death data. These instances included more than 7,000 numbers “where the reported date of death occurred prior to enrollment” in the Exchange, and more than 19,000 numbers where “matches had different names and dates of birth” between the Exchange database and the Social Security Administration database, a potential sign of “synthetic identity fraud.”

The article concludes:

Regardless, lawmakers should not spend another $350 billion (plus interest) throwing good taxpayer money after bad, even as one government report after another shows Exchange-related fraud remains out of control. After incurring more than $38 trillion in debt, Washington should finally realize it has run out of other people’s money to spend on such profligacy.

It is past time to make the subsidies go away and find a better way to do healthcare.

There Are Some Serious Fraud Problems In Medicaid

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On October 17th, American Greatness posted an article about Medicaid fraud in Charlotte, North Carolina.

The article reports:

The FBI on Thursday raided the home of Cedric Dean, a notorious community activist in Charlotte, North Carolina.

Federal investigators accuse Dean of exploiting homeless people to defraud Medicaid out of millions of dollars. According to federal court documents, Dean used the money to buy homes, cars and more to fund his exorbitant lifestyle. The Feds said they were moving to seize those assets.

According to the civil forfeiture complaint filed by the FBI, Dean allegedly obtained Medicaid information from vulnerable people at homeless shelters, encampments, and halfway houses in North Carolina, in exchange for food or temporary shelter.

Dean then allegedly billed Medicaid for mental health services that were never provided, sometimes using fake diagnoses. He allegedly paid his staff through services like CashApp.

Authorities said his company, Cedric Dean Holdings (CDH), billed Medicaid approximately $14.5 million between September 2024 and June 2025, with nearly $9 million reimbursed, while not operating with enough staff to adequately provide services.

The Feds have seized his bank accounts, vehicles, including two RVs and luxury SUVs, and multiple properties in Charlotte and Shelby, that were allegedly purchased with fraud earnings.

Neighbors who live near one of Dean’s properties in Charlotte, told the media they were concerned about the suspicious nonstop activity at the address.

So he applied for $14.5 million and actually received $9 million. Based on the article, it is amazing it has taken so long to catch up with this person.

The article notes:

Dean has a criminal record dates back to the 1980s, including charges of assault, armed robbery, and kidnapping, according to police.

He was sentenced to life imprisonment in the mid 1990s on federal drug charges.

While in prison, he started an anti-violence foundation, SAVE (Safeguard Atone Validate Educate), to steer children away from gangs. In November 2017, he was released from prison after serving nearly 24 years behind bars.

Dean is also the founder and CEO of the HELP (Heal, Empower, Love, Protect), a substance abuse program that houses people at a north Charlotte hotel.

The article concludes:

The Department of Justice announced in June that its “National Health Care Fraud Takedown” had resulted in 324 defendants charged in connection with over $14.6 billion in alleged fraud.

The Capital Research Center (CRC), a conservative watchdog based in Washington D.C., recently released a report exposing how left-wing organizations have hijacked the homelessness policy space to advance their radical ideologies. CTC’s 113-page research dossier landed on President Trump’s desk last week during the White House’s Antifa roundtable.

When the government is involved in a program, fraud will often follow.

Here’s One Place We Can Cut Government Spending

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The Washington Examiner posted a story today about Medicaid fraud. Medicaid is the federal program that provides medical care to people who can’t afford it.

The article reports:

Healthcare providers banned from Medicaid may have been reimbursed $213 million in federal money, thanks to a state agency oversight, a government watchdog reported.

Valid identification numbers — identifiers that ensure providers are eligible for Medicaid reimbursements — were missing from 800,000 Colorado claims in 2011, the U.S. Department of Health and Human Services inspector general reported Wednesday.

The state reimbursed the providers $424.4 million for the claims, of which, $213 million was federal money.

Regardless of how you feel about government-provided healthcare and whether or not it is constitutional, a $213 million dollar savings in federal spending would be nice. If one state has that much Medicaid fraud, how much do the other states have?

The article goes on to explain that the computer system in Colorado was not able to alert officials to missing or incorrect identification numbers and that the problem would not be corrected until 2016. However, the agency is now denying claims with invalid or missing numbers. It sounds like Colorado is working with the same programmers that designed the ObamaCare website.