Yesterday with Secretary Kennedy, I zeroed in on one of the ugliest fraud magnets in Medicaid. In New York, a program meant to care for the vulnerable has been twisted into a fraud-soaked jobs scheme, with roughly 250,000 enrollees, about 400,000 caregivers, and spending that exploded from $2.5 billion in 2019 to an estimated $12 billion in 2025. If New York’s Medicaid spending matched the national average, the savings would be almost $43 billion. That is why I introduced the Combating Deceptive Practices in Assistance Programs Act of 2026 to put real guardrails back in place.
Back to News
CLICK HERE to read the FULL New Schweikert Bill Takes Aim at Medicaid Fraud article.
PAYROLL & HR CONTROLS (PREVENTING “GHOST” SCHEMES)
Payroll fraud is often the hardest to detect because it “looks” like a normal business expense.
- Segregation of Duties (SoD): The person who adds new employees to the system must not be the same person who approves the monthly pay run.
- Mandatory Vacation Policy: Require all financial and HR staff to take 5–10 consecutive days of leave annually. Fraud often surfaces when the perpetrator isn’t there to “hide” the trail.
- Ghost Employee Audit: Perform a quarterly “Headcount Reconciliation” where managers must physically verify every name on their payroll list exists.
- Self-Pay Blocking: Ensure the payroll software has a hard-coded block preventing administrators from editing their own salary or bank details.