Yes.
The majority of Medicaid fraud is committed by providers. Fraud by beneficiaries, like selling prescription drugs or sharing a Medicare card, occurs less frequently and tends to be smaller in scale.
Common types of Medicaid provider fraud include upcoding, a practice that involves billing for a more expensive service than was provided, and submitting false claims, such as for diagnoses a patient does not have or services that were not provided.
Over the past several years, a network of behavioral health facilities in Arizona defrauded the state Medicaid program, the Arizona Health Care Cost Containment System (AHCCCS), of up to $2.5 billion in taxpayer dollars. The facilities recruited unhoused populations and Native Americans, ultimately charging Medicaid exorbitant fees for services that were inadequate or not provided at all.
This brief responds to conversations such as this one.
The Arizona Center for Investigative Reporting partners with Gigafact to produce fact briefs, or quick-response fact checks, about trending claims relating to Arizona.
Sources
- U.S. Department of Justice, National Health Care Fraud Enforcement Action Results in 193 Defendants Charged and Over $2.75 Billion in False Claims
- U.S. Government Accountability Office, Medicare and Medicaid: Additional Actions Needed to Enhance Program Integrity and Save Billions
- U.S. Department of Justice and U.S. Department of Health and Human Services, Health Care Fraud and Abuse Control Program FY 2023
- Federal Bureau of Investigation, Health Care Fraud
- U.S. Department of Health and Human Services, Fact Sheet: Common Types of Health Care Fraud
- U.S. Department of Health and Human Services, There Are Many Types of Medicaid Fraud
- U.S. Department of Justice, Combating Health Care Fraud: 2024 National Enforcement Action
- Arizona Center for Investigative Reporting, Dozens of people died in Arizona sober living homes as state officials fumbled Medicaid fraud response
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The Arizona Center for Investigative Reporting is partnering with Gigafact to produce timely fact briefs, or quick-response fact checks, about trending claims relating to Arizona.
