Cracking Down on Fraud and Respecting Taxpayers: The Medicare and Medicaid Fraud Prevention Act

By Isabel Soto, Policy Director for The LIBRE Initiative

Our government should ideally work in such a way that the programs it is responsible for operate effectively, efficiently and honor taxpayer needs and dollars. Unfortunately, much of our government run health care is riddled with inefficiencies. Medicare and Medicaid for example are meant to help seniors and low-income individuals, but without proper review to ensure the benefits make it to the right hands, fraud and improper payments can rapidly become a serious problem.

The Medicare and Medicaid Fraud Prevention Act, introduced by Representative Gabe Evans (CO-08) and Representative Scott Peters (CA-50) bring a commonsense solution to the very serious problem of improper payments that threaten the fiscal health of these important programs. This bill would require additional screening to ensure payments are only going to eligible and, in this case, living beneficiaries.

Regardless on opinions around the effectiveness and proper spending related to government programs, there is agreement that benefits should go to beneficiaries and no one else. Over the last decade, there were only 2 audits conducted by the Centers for Medicare and Medicaid Services (CMS) of state Medicaid programs and they found that the rate of improper payments surpassed 25%. This means that over a quarter of payments that went out from state Medicaid did not go where they should have and could have been the result of fraud. This 25% rate totals $1.1 trillion in improper payments over the past decade. Given that there have only been 2 complete audits it is likely this $1.1 trillion is a conservative estimate and highlights that perhaps a not insignificant share of taxpayer dollars have gone to deceased beneficiaries and the scammers that take advantage of the gaps in our health care system.

It’s no wonder Medicare and Medicaid spending has grown so rapidly when there has been minimal assessment of payments or eligibility reviews. Curtailing improper payments and reintroducing proper accountability into two of the government’s largest spending programs would ensure that taxpayer money is used responsibly. Fighting fraud doesn’t cut care – it ensures Medicaid works for those who need it.

Medicare and Medicaid are programs that are meant to help individuals who would otherwise struggle to access care. Our nation’s seniors and low-income individuals are already dealing with a complex, outdated health care system and excess spending doesn’t just endanger the program it drives down quality of care.

The Medicare and Medicaid Fraud Prevention Act, which passed unanimously under suspension in the 118^th Congress, is a crucial piece of legislation that ensures Medicaid remains a strong, effective safety net instead of another unmanageable entitlement. Reforms like this aren’t just honoring taxpayers and their contributions but also protecting a building a system that allows us to spend smarter and build better short- and long-term sustainability