As a program that requires huge financial spending, Medicaid is not devoid of fraud and abuse. The initiative is funded by states and federal budgets, which means that a part of taxpayers’ money is wasted due to medical providers stealing money from the Medicaid budget. Fraudulent practices do not only make the healthcare system inefficient but also pose danger to the patients who are prescribed unnecessary drugs or offered unnecessary tests.
Medicaid fraud takes place when providers of health care services abuse their authority. They are not only physicians but also entire organizations such as hospitals, pharmacies, adult day care centers. As individuals receive services from these providers, the state is billed. Sometimes services provided to nonexistent patients are billed or a payment for nonexistent services is withdrawn. In fact, physicians find numerous ways to charge the government for services that do not enhance the recovery of their patients.
Each person using Medicaid services can spot the fraud and report it to the Medicaid office. Each of them receives an Explanation of Benefits where people can see all the services they received. It can be easy for an individual to notice services they never received and report fraud to the authorities. Medicaid providers can easily manipulate their patients, thus, consumers shall think over every suspicious recommendation. To avoid damage done by light-fingered providers, patients shall better ask for an alternative opinion.
Federal organizations do their best to prevent fraud in Medicaid as well. Under the Affordable Care Act, states can compare information on healthcare providers to check whether they are terminated by Medicaid or not. Besides, providers undergo thorough screening as the Medicaid office checks out their licenses, previous activity, and criminal background.