While the launch of the Affordable Care Act has been rocky, one potential bright spot is the number of people signing up for Medicaid expansion. This is the new program aimed at the working poor — people who make too much money to qualify for existing Medicaid benefits, but too little to afford coverage in the private market. More than 21 million Americans fall into this category.
In Kentucky, for example, eight of 10 healthcare enrollees qualify for this program so far.
It’s anybody’s guess how many people will sign up for expanded Medicaid, but it’s likely to be millions over the next few years. And for crooked Medicaid providers, that’s millions of new opportunities to commit fraud.
Medicaid continues to have significant exposure to fraud in many states. Crooked medical providers reap billions of dollars each year from a variety of scams. The schemer could be a nurse in Georgia billing Medicaid to treat dead people, or a dietician also in Georgia stealing IDs of children or a cardiologist in New Jersey lying to patients that they have serious heart disease. And these are cases just from the last few days.
Medicaid is especially vulnerable to scams. Good laws, adequate resources and the determination to resist fraud are lacking in many states.
Medicaid recipients are especially susceptible. They tend to know less about how insurance works, are less likely to question a doctor’s diagnosis and may be more willing to overlook cheating by Medicaid providers. Crooks take advantage by offering recipients a few dollars to hand over their Medicaid policy numbers. Other medical providers have bribed parents to let them “treat” their kids.
The money the federal government sends to states to expand Medicare provides few new fraud-fighting dollars.
Before their rolls swell, Medicaid programs should gear up for what’s likely to be alarge rise in suspect claims. More enrollees equals more claims — and more opportunities for savvy fraudsters to ply their trade under the radar of fraud fighters.
About the author: Dennis Jay is executive director of the Coalition Against Insurance Fraud.