Pennsylvania Cracks Down on Medicaid Fraud

According to a recent article on the Pottstown Mercury, since 2010 Pennsylvania has recovered more than $117 million due to Medicaid fraud and most of the money is going back to the Medicaid program.
This fraud, according to the article, has contributed to rising health care costs with at least 10 percent of state taxpayers affected by the increased costs.
Medicaid is a state-run program with an annual budget of $4.5 billion in state and federal funds and provides health care for low-income Americans. One-third of all children receive care through Medicaid, as do low-income pregnant women, disabled or blind people and nursing home patients, according to the U.S. Justice Department.
More than 50,000 health-care providers, including physicians, dentists, podiatrists, chiropractors, hospitals, home health agencies, ambulance companies, nursing homes, nurses and pharmacies contract with Pennsylvania’s Medicaid program to provide health-care services to more than 1.5 million recipients.
Fraudulent activity has included billing for services not rendered, misrepresentation of services, false cost reports, kickbacks, medically unnecessary services and substandard care. Over the past three years, the Attorney General’s Office has averaged about 60 arrests, including providers, pharmacists and other professionals, Nils Frederiksen, a spokesman for Pennsylvania Attorney General Linda Kelly, said in the Mercury article.

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