Medicare and Medicaid Cost $1.7 trillion in 2023, but Fraud is Not Being Addressed
On April 16, the Inspector General for Health and Human Services testified to Congress on the damage wrought by fraud on the Medicare and Medicaid health care programs. The IG began by noting that in FY 2023, Health and Human Services consumed almost 24% of the federal budget, amounting to $2 trillion. The vast bulk of this — $1.7 trillion — was spent on Medicare and Medicaid, which service a whopping 40 percent of the U.S. population.
These numbers are truly astounding, but even more striking is the extent to which fraud is not being addressed. The IG declared that “more oversight and enforcement are needed to keep pace with the size, scope, and complexity of the health care industry, HHS programs, and fraud schemes … our limited resources do not allow us to provide the level of comprehensive oversight of Medicare and Medicaid that is needed and should be expected by the American public.” The IG claimed that her office has had to turn down “between 300 and 400 viable criminal and civil health care fraud cases each year.”
While these statements were made in an effort to secure more funding, the Inspector General could also have championed the contribution that whistleblowers have made, and will continue to make, to fighting health care fraud, both in terms of information and resources. In FY 2023, False Claims Act qui tam cases involving Health and Human Services programs returned $1.6 billion to taxpayers, which is 69% of $2.3 billion recovered in all qui tam cases for that year. Health care fraud cases consistently account for the bulk of qui tam recoveries — since 1986, $40.4 billion of $52.7 billion in total recoveries.
Yes, the Inspector General should have more funds to hire more agents, analysts and data scientists. But don’t overlook the concerned citizens who bravely report fraud that would otherwise remain hidden and the resources they and their counsel bring to investigating, prosecuting, and recovering the spoils of fraud for the American public.
Getnick Law has partnered with whistleblowers in this effort for three decades. Contact us for more information or to discuss a potential case.