Medicaid Fraud: Actions,Actors,and Policy

Abstract

Health care reform and crime are two current controversial political issues. Combining the two topics, this research examines the criminal acts brought to the attention of Medicaid Fraud Control Units throughout the United States. To address the fraudulent actors and actions involved in Medicaid fraud, 572 incidents of Medicaid fraud reported to the units are analyzed. Also, findings from a survey of unit directors are included to describe the problems the units face battling the fraudulent activities. Findings indicate that various types of fraud are committed by all types of health care providers and societal changes make the task of prosecuting fraud problematic. Implications and recommendations are provided in the conclusion.