Medicaid Gatekeepers Fail to Catch Billions in Fraud: The Brief

THE FEDERAL GOVERNMENT loses billions of dollars a year because the state health departments and contractors it relies on to keep Medicaid spending honest either don’t catch blatant fraud or ignore it, John Holland and Celine Castronuovo report.

• Instead of providing checks on one another, states and contractors often work together to approve as many claims as possible — even for questionable expenditures such as yearslong hospitalizations for routine medical problems or services rarely allowed at nursing homes, a Bloomberg Law investigation found. Approving claims keeps federal dollars rolling into states and contractors. The biggest is Texas-based Gainwell Technologies, which ...