Medicaid waste, fraud, and abuse arise from several primary sources: legalized money laundering schemes and resulting corporate welfare; ineligible enrollees in the program; eligibility errors that allow ineligible individuals to enroll and remain enrolled; vulnerable service categories with weak oversight that create opportunities for fraud; and limited transparency, particularly in managed care. The following is a menu of policy options for states to pursue to curb waste, fraud, and abuse in their Medicaid programs and preserve the program for the truly needy.
I. Reducing Legalized Medicaid Money Laundering and Corporate Welfare
States are becoming increasingly reliant on federal sources to finance Medicaid. They utilize financing schemes, such as provider taxes and intergovernmental transfers, to draw down additional federal funding. These financing mechanisms result in large payments…
HOW TO SPOT A “RED FLAG” (THE BEHAVIORAL AUDIT)
Keep an eye out for these behavioral shifts in your staff:
Refusal to take leave: Afraid someone will find their “adjustments.”
Unexplained wealth: Buying luxury items that don’t match their known salary.
Working odd hours: Preferring to work alone late at night when no one is watching the system.
“Gatekeeper” behavior: Becoming overly defensive or angry when someone asks to see their records.