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Federal watchdog warns fraudsters diverting taxpayer money from Medicare and Medicaid

A federal watchdog has reported that fraud schemes are diverting taxpayer money from Medicare and Medicaid programs, amounting to nearly $27 million in losses. This alert comes as the Trump administration takes steps to reduce waste and fraud in federal programs.

1. Fraud Scheme Details:

• Fraudsters impersonated hospital providers to target contractors and state agencies.

• They submitted false electronic funds transfer requests to steal funds from Medicare and Medicaid programs.

2. Involvement of DOGE:

• Under the direction of Elon Musk, the Department of Government of Efficiency (DOGE) is reviewing federal programs to find and eliminate waste.

• Musk indicated that his team suspects significant fraud exists within federal healthcare programs.

3. Extent of the Problem:

• The Health and Human Services Department's Inspector General (HHS OIG) reported widespread awareness among Medicare and Medicaid payors of ongoing fraud schemes.

• Approximately 66% of payors recognized they have been targeted, with financial losses reported by half of those affected.

4. Nature of Fraud:

• The fraud schemes often involved phishing attacks and impersonation tactics.

• Reported financial losses due to these schemes ranged from $140,000 to $1 million.

5. Potential for More Losses:

• The OIG warned that undetected fraud might be more extensive, especially among payors lacking sophisticated detection systems.

6. Financial Impact on Programs:

• Medicare and Medicaid expenditures account for about 22% of the total U. S. spending, which leads to increased vulnerability to fraud attempts.

• In 2023, improper payments could exceed $100 billion across both programs.

7. Other Fraud Cases:

• Recent actions by the Justice Department led to charges against 193 defendants related to health care fraud, resulting in $1. 6 billion in losses.

• Notable cases include fraudulent claims for unnecessary surgeries and illegal prescription practices involving addictive substances.

The ongoing fraud targeting Medicare and Medicaid highlights vulnerabilities within these vital health programs. The actions by federal agencies, particularly under the DOGE initiative, aim to combat significant fraud and improve accountability. However, the scale of financial losses indicates that these programs remain at high risk for exploitation. 

https://justthenews.com/accountability/watchdogs/inspector-general-warns-fraud-scheme-divert-federal-and-state-medicare-and

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