Medicare and Medicaid exist to provide care to seniors, people with disabilities, and low-income families—not to enrich those who exploit them. Every dollar lost to fraud is a dollar that cannot be spent providing legitimate care.
On October 22, the U.S. Department of Justice announced charges against 15 people in Southern California accused of submitting more than $1.8 billion in fraudulent claims to government healthcare programs and private insurers. The alleged schemes included exploiting vulnerable people seeking addiction treatment to bill for services they didn’t receive and performing unnecessary procedures to clear plaque from Medicare patients’ arteries, sometimes leaving them injured.
Just days earlier, federal agents and New York authorities targeted more than 100 adult day-care providers in an investigation into suspected Medicaid fraud.
The Trump administration’s high-profile investigations have attracted attention for their theatrical presentation. But the underlying problem is anything but a spectacle. Medicare and Medicaid are vulnerable to staggering amounts of improper spending, and patients suffer when unscrupulous providers exploit the programs.
Consider Medicare. Last year, the federal government made an estimated $28.8 billion in improper payments through traditional Medicare, $23.7 billion through Medicare Advantage, and another $4.2 billion through Medicare’s prescription drug benefit.
Not every improper payment is fraudulent. The category includes insufficiently documented claims, violations of program rules, and administrative mistakes.
But the figures reveal the enormous challenge of ensuring that Medicare pays only for legitimate, properly documented care.
Medicaid’s record is similarly troubling. According to the Centers for Medicare and Medicaid Services, the program made an estimated $37.4 billion in improper payments in fiscal 2025. More than three-quarters involved insufficient documentation.
Nothing contained in this blog is to be construed as necessarily reflecting the views of the Pacific Research Institute or as an attempt to thwart or aid the passage of any legislation.
Healthcare Fraud Doesn’t Just Cost Taxpayers. It Hurts Patients.
Sally C. Pipes
Medicare and Medicaid exist to provide care to seniors, people with disabilities, and low-income families—not to enrich those who exploit them. Every dollar lost to fraud is a dollar that cannot be spent providing legitimate care.
On October 22, the U.S. Department of Justice announced charges against 15 people in Southern California accused of submitting more than $1.8 billion in fraudulent claims to government healthcare programs and private insurers. The alleged schemes included exploiting vulnerable people seeking addiction treatment to bill for services they didn’t receive and performing unnecessary procedures to clear plaque from Medicare patients’ arteries, sometimes leaving them injured.
Just days earlier, federal agents and New York authorities targeted more than 100 adult day-care providers in an investigation into suspected Medicaid fraud.
The Trump administration’s high-profile investigations have attracted attention for their theatrical presentation. But the underlying problem is anything but a spectacle. Medicare and Medicaid are vulnerable to staggering amounts of improper spending, and patients suffer when unscrupulous providers exploit the programs.
Consider Medicare. Last year, the federal government made an estimated $28.8 billion in improper payments through traditional Medicare, $23.7 billion through Medicare Advantage, and another $4.2 billion through Medicare’s prescription drug benefit.
Not every improper payment is fraudulent. The category includes insufficiently documented claims, violations of program rules, and administrative mistakes.
But the figures reveal the enormous challenge of ensuring that Medicare pays only for legitimate, properly documented care.
Medicaid’s record is similarly troubling. According to the Centers for Medicare and Medicaid Services, the program made an estimated $37.4 billion in improper payments in fiscal 2025. More than three-quarters involved insufficient documentation.
Read the entire op-ed here.
Nothing contained in this blog is to be construed as necessarily reflecting the views of the Pacific Research Institute or as an attempt to thwart or aid the passage of any legislation.