The FAST Solution to Medicare and Medicaid Fraud

July 1, 2011
by: Erica Gordon

Wastewatcher

Each year, Americans lose tens of billions of their hard-earned tax dollars to Medicare and Medicaid waste, fraud, and abuse. The most recent estimates from the Centers for Medicare & Medicaid Services (CMS) indicate that there was nearly $48 billion in improper payments for Medicare and $22.5 billion in the federal share of improper payments in Medicaid in fiscal year 2010. These figures are just the tip of the iceberg and do not include the countless, undocumented occurrences of theft carried out by organized crime rings aimed at defrauding Medicare, the stealing and selling of beneficiary numbers on the black market, and the creation of front groups and fake doctors’ offices that cheat the system at the taxpayers’ expense.

Hundreds of news stories about individuals and fake organizations swindling money from Medicare and Medicaid coffers highlight the severity of the issue and the need for critical reforms. In June 2010, the New Jersey Medicaid Inspector General demanded that an adult medical day care center pay a $5.6 million civil penalty for submitting false Medicaid claims. The day care center allegedly pocketed $1.87 million for services that were never rendered. In October 2010, in what was described by the FBI as the “largest Medicare fraud scheme ever committed by a single enterprise,â€