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The Success of Medicaid Fraud Control Units

Prosecuting health care professionals and businesses has become big business in Washington D.C. In 2010, the government obtained more than $1.85 billion in Medicaid fraud prosecutions. That is nearly three times the amount they gained just six years prior. The money gained is a reflection of the increase in the money the government now spends investigating and prosecuting health care fraud.

State Medicaid Fraud Control Units received more than $200 million in grants last year. The federal government has also stepped up funding for anti-fraud efforts. With Medicare and Medicaid being held up as models for national health care, the government is more interested than ever in combating fraud and making headlines for their efforts. The climate is ripe for aggressive prosecution of anyone who has submitted improper claims to these programs.

Much of the effort expended by investigators and prosecutors has been centered on fraud hot spots like Florida and Texas. The current level of prosecution may just be the tip of the iceberg. Advancements in data analysis and claim tracking may soon allow investigators to identify fraud more easily. The contractors used to audit Medicaid claims are now required to report possible fraudulent billing to law enforcement professionals.

Everyone from individual doctors to home therapy and medical equipment businesses is a potential target. By many accounts, the efforts have exposed only a small fraction of fraudulent claims being made. The government's success so far will likely spur further efforts to pursue criminal complaints against those suspected of Medicaid fraud.

Source: USA Today, "Government triples money recovered from Medicaid scams," Kelly Kennedy, 19 October 2011

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