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GAO: Medicaid: Additional Actions Needed to Help Improve Provider and Beneficiary Fraud Controls

May 1, 2015

Pursuit's Take

GAO found thousands of Medicaid beneficiaries and hundreds of providers involved in potential improper or fraudulent payments during fiscal year 2011—the most-recent year for which reliable data were available in four selected states: Arizona, Florida, Michigan, and New Jersey. These states had about 9.2 million beneficiaries and accounted for 13 percent of all fiscal year 2011 Medicaid payments. Specifically:

About 8,600 beneficiaries had payments made on their behalf concurrently by two or more of GAO’s selected states totaling at least $18.3 million.

The identities of about 200 deceased beneficiaries received about $9.6 million in Medicaid benefits subsequent to the beneficiary’s death.

About 50 providers were excluded from federal health-care programs, including Medicaid, for a variety of reasons that include patient abuse or neglect, fraud, theft, bribery, or tax evasion.

Medicaid is a significant expenditure for the federal government and the states, with total federal outlays of $310 billion in fiscal year 2014. CMS reported an estimated $17.5 billion in potentially improper payments for the Medicaid program in 2014.

Media Coverage

Long-Term Living: GAO suggests ways to fight Medicaid fraud, improve Medicare audits

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