Study: Feds struggle to prosecute Medicaid fraud

Sunday, June 8, 2003

June 9, 2003

WASHINGTON - The federal government recovers 20 times more money from prosecuting Medicare fraud cases than from prosecuting Medicaid fraud cases, according to two studies released last week by the Taxpayers Against Fraud.

The studies found that in 2001, the federal government recovered more than $1 billion from Medicare fraud prosecution, compared with $43 million from Medicaid fraud prosecution. The recovery rate trend has been consistent over the last five years, the Hartford Courant reported.

The fraud recovery discrepancies between Medicare and Medicaid appear to be associated with the fact that 39 states have not adopted a local version of the federal False Claims Act, which gives prosecutors broad power to combat fraud and protects whistleblowers who report Medicare and Medicaid fraud.

Although the False Claims Act cannot be applied to the states' share of Medicaid fraud because it is a federal law, states initiate investigations for the crime.

James Sheehan, assistant U.S. attorney in Philadelphia, told the Current that the level of fraud is probably about the same in the two programs.

Sheehan added that the False Claims Act is crucial to recovery in Medicare fraud, saying: "How do we get all these cases? Whistleblowers."