United States General Accounting Office
Testimony
GAO Before the Subcommittee on Oversight and Investigations,
Committee on Commerce, House of Representatives
For Release on Delivery
Expected at 10:30 a.m.
Tuesday, November 9, 1999 MEDICAID
Federal and State
Leadership Needed to
Control Fraud and Abuse
Statement of Leslie G. Aronovitz, Associate Director
Health Financing and Public Health Issues
Health, Education, and Human Services Division
GAO/T-HEHS-00-30
Medicaid: Federal and State Leadership
Needed to Control Fraud and Abuse
Mr. Chairman and Members of the Subcommittee:
We are pleased to be here today as you discuss ways to combat fraud and
abuse in the Medicaid program. Some 40 million Americans—not only
poor mothers and children but also poor elderly, blind, and disabled
individuals—depend on health care services made possible by the
Medicaid program. With total expenditures of over $177 billion in fiscal
year 1998, Medicaid is the third largest social program in the federal
budget and represents a significant share of individual state budgets as
well.
Fraud and abuse drains away vital program dollars and exploits taxpayers
and vulnerable beneficiaries. As we recently reported, consumers and
legitimate health care providers have been victimized by the fraud
schemes of career criminals and organized criminal groups.1 While the
Department of Health and Human Services (HHS) and the Department of
Justice have recently augmented their program integrity activities for
Medicare, the Congress is concerned that a similar emphasis be placed on
fraud and abuse control in Medicaid. We have just launched a study to
better understand the scope and effectiveness of Medicaid program
integrity efforts at the federal and state levels and will report our results
next spring. Today, my remarks will focus on a brief overview of the
problem, several key components of fraud control, and the importance of
federal and state cooperation. My comments are based on observations
gleaned from our prior work addressing both Medicaid and Medicare
program integrity issues and from our ongoing Medicaid study.
In summary, our body of work on health care fraud and abuse indicates
that programs the size and structure of Medicaid are inherently vulnerable
to exploitation. Fraud schemes often cross state lines and enforcement
jurisdictions, entailing a number of federal, state, and local agencies that
may have different or competing priorities in their efforts to investigate,
prosecute, and enforce compliance. Experience shows that coordinating
the efforts of the multiple players, investing in preventive strategies, and
dedicating adequate resources to fraud control units are essential
components of an effective program integrity strategy. Finally, our work
shows that the Health Care Financing Administration (HCFA), the agency
in HHS responsible for administering Medicaid federally, is in a position to
work in partnership with the states to ensure an appropriate level of
commitment in states’ efforts to control Medicaid fraud and abuse.
1Health Care: Fraud Schemes Committed by Career Criminals and Organized Criminal Groups and
Impact on Consumers and Legitimate Health Care Providers (GAO/OSI-00-1R, Oct. 5, 1999).
Page 1 GAO/T-HEHS-00-30
Medicaid: Federal and State Leadership
Needed to Control Fraud and Abuse
Background Medicaid is a jointly funded federal-state health insurance program for
eligible low-income and needy people. Although it is one federal program,
as a practical matter, it consists of 56 separate programs (including the
District of Columbia, Puerto Rico, and the U.S. territories). Within broad
federal guidelines, each state establishes its own eligibility standards;
determines the type, amount, duration, and scope of services; sets the rate
of payment for services; and administers its own program. For fiscal year
1998, federal Medicaid expenditures were over $101 billion, with the states
contributing about $76 billion. For each state, the federal share varies
according to a statutory formula. The federal government picks up at least
half the cost for medical services, and in nine states, it pays for more than
70 percent.
Medicaid fraud and abuse control entails a complex mix of actors and
entities. At the federal level, HCFA and the HHS Office of Inspector
General (OIG) have program oversight responsibilities. The Federal
Bureau of Investigation (FBI) and the U.S. Attorneys in the Department of
Justice are responsible for enforcement under certain conditions.
However, front line oversight and enforcement reside primarily with the
states. Each state administers its Medicaid program through a state
Medicaid agency—variously situated in departments such as health,
welfare, or human services. In addition to paying claims and performing
other administrative duties, the state Medicaid agencies conduct program
integrity activities. Many state Medicaid agencies have a “data mining”
unit—a surveillance and utilization review subsystem (SURS) unit—
dedicated to reviewing paid claims to identify suspect billing practices or
other aberrations indicating potential wrongdoing. Separate from the state
Medicaid agency, 47 states have Medicaid Fraud Control Units (MFCU),
generally located in the state’s attorney general’s office, which carry out
investigations and prosecutions. For a composite view of the multiple
agencies involved in Medicaid fraud and abuse control, see table 1.
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Medicaid: Federal and State Leadership
Needed to Control Fraud and Abuse
Table 1: Overview of Medicaid Fraud and Abuse Control Efforts
Agency Responsibility Related activities
Federal
Department of Health and Human Services (HHS)
Health Care Financing Oversees state Medicaid agencies Among other activities, through its Medicaid Fraud and
Administration (HCFA) Abuse National Initiative, HCFA provides an ongoing
forum and training for state officials on fraud control.
Office of Inspector Oversees state Medicaid Fraud Control The OIG can sanction fraudulent providers by imposing
General (OIG) Units exclusions and civil monetary penalties. It refers
investigative findings to Department of Justice.
Investigates federal Medicaid fraud
cases
Department of Justice
U.S. Attorneys Prosecute Medicaid fraud cases The U.S. Attorneys also indict, negotiate settlements,
referred by FBI and HHS OIG and make recoveries.
Federal Bureau of Investigates federal fraud cases but The FBI refers investigative findings to the U.S.
Investigation (FBI) cannot impose sanctions Attorneys.
State
State Medicaid agency Administers state Medicaid program and The state Medicaid agency’s activities may include
(located in such oversees Medicaid program integrity conducting pre- and postpayment claims reviews and
departments as health, activities administering the provider enrollment process.
human services, and
welfare)
Program integrity/ Reviews claims data to detect and SURS units refer suspected fraud cases to the state’s
surveillance and investigate aberrant payment patterns MFCU and noncriminal cases to the state Medicaid
utilization review and conducts other types of integrity agency’s collection unit.
subsystem (SURS)a unit activities
Medicaid Fraud Control Investigates and prosecutes cases The MFCU may refer cases that will not be prosecuted to
Unit (MFCU)b (generally in involving fraudulent Medicaid activities the state Medicaid agency or other authority for
state attorney general’s administrative action.
office) Investigates and acts on complaints of
abuse or neglect of patients in facilities
receiving Medicaid funding
Local
District attorney Prosecutes Medicaid fraud cases in
states where MFCUs do not have
prosecutorial authority
a
States vary in how their program integrity activities are organized and in what the units
are called.
b
Three states do not have MFCUs–Idaho, Nebraska, and North Dakota.
Fraud and Abuse Are a The magnitude of fraud and abuse in the Medicaid program has not been
quantified. Nevertheless, similar fraud and abuse schemes crop up in
Persistent Problem in different states, and states have problems with fraud and abuse under both
Medicaid Program fee-for-service and managed care payment methods. Medicaid is
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Medicaid: Federal and State Leadership
Needed to Control Fraud and Abuse
vulnerable to fraud because of some intrinsic characteristics—such as its
share of states’ budgets and its vulnerable beneficiary population.
Several Types of Fraud and Common Medicaid fraud and abuse schemes generally fall into three
broad groups: improper billing practices, misrepresentations of
Abuse Are Common in professional or service qualifications, and improper business practices.2
Medicaid Improper billing practices include “upcoding,” in which the provider
misrepresents treatment provided and bills for a more costly procedure;
“ghost” or “phantom” billing, in which a provider bills for services never
provided; and delivering more treatment than is either necessary or
appropriate for the patient’s diagnosis. Misrepresenting qualifications
encompasses such offenses as submitting false credentials to obtain a
Medicaid provider number and performing treatments outside the bounds
of what is permitted by one’s license. Among the improper business
practices found in Medicaid are kickbacks for referring or otherwise
steering patients to a particular provider or product such as
pharmaceuticals; self-referrals, in which providers, for example, may order
and request lab tests from companies they own or have a financial interest
in; and antitrust violations, in which companies collude with each other or
with providers to improperly influence payments or fees. Table 2 contains
examples of fraud and abuse cases from the files of state MFCUs.
2Fraud involves a willful act to deceive for gain, whereas abuse typically involves actions that are
inconsistent with acceptable business and medical practices.
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Medicaid: Federal and State Leadership
Needed to Control Fraud and Abuse
Table 2: Examples of Medicaid Fraud and Abuse
Type of fraud Example
Billing fraud A psychiatrist operated a “psychotherapy mill,” in which parents were enticed to enroll their
children in “free” enrichment programs such as after-school tutoring, field trips, and supervised
recreation in exchange for their children’s Medicaid numbers. Using these numbers, the
psychiatrist billed Medicaid for psychotherapy services not provided. A psychologist he employed
discovered the scam and negotiated a higher salary from him. The psychologist also set up her
own copycat operation. State officials estimated that the two fraudulently obtained $421,000 from
Medicaid. The defendants pleaded guilty, were ordered to pay fines and restitution, and received
probation. Source: Georgia State Health Care Fraud Control Unit.
Business practices fraud Two businessmen pleaded guilty to felony charges related to a complex scheme of submitting
fraudulent nursing home cost reports to the state’s Medicaid program. The scheme involved a
nursing home chain and a shell corporation that the chain allegedly contracted with, enabling the
owners to bill Medicaid for inflated expenses related to phony contracts with the nursing homes.
Through a complex web of bank and investment accounts, the owners laundered payments. The
scheme, which netted the owners nearly $10 million in excess Medicaid reimbursements, was
discovered when a state auditor became suspicious of high payments to the shell company. One
of the defendants received 50 months in prison and a $70,000 fine; the other, 36 months in prison
and a $50,000 fine. Both received an additional 3 years of supervised release. As restitution, the
pair agreed to pay about $6 million to the state Medicaid program and to forfeit an additional $2-
million-plus in assets. Source: Georgia State Health Care Fraud Control Unit.
Fraudulent misrepresentation of A woman, who had never attended, graduated, or received a degree from a nursing school,
qualifications presented a false nursing license to several nursing homes that employed her. She also
contracted with a county Board of Mental Retardation and Developmental Disabilities to provide
nursing and counseling services. The misrepresentation was discovered when substandard care
she provided led to complaints and a subsequent investigation. A state nursing board determined
that the woman had posed as a nurse for at least 5 years. She was charged with felony Medicaid
fraud, felony forgery, and misdemeanor practice of unlicensed nursing. She pleaded guilty and
was sentenced to 5 years’ probation and was ordered to either pay some $3,850 in restitution or
perform 84 days of community service. Source: Ohio Attorney General’s Health Care Fraud
Section.
Fee-for-service providers do not have a monopoly on fraudulent and
abusive health care practices. Under managed care, providers intending to
exploit the program have adapted to new financial incentives. Whereas
receiving a fee for each service enables providers to enhance revenues by
ordering too many services, receiving a lump-sum payment in advance for
each enrollee can encourage dishonest providers to enhance their profits
by stinting on patient care. Consistent with this incentive are examples of
Medicaid managed care fraud and abuse by prepaid health plans: avoiding
expensive treatments, underfinancing plan operations, providing poor
quality care, using deceptive marketing practices, and claiming phony
enrollments. In a specific instance in Tennessee, a managed care plan used
a homeless shelter as the address for nearly 4,500 fictitious enrollees—a
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Medicaid: Federal and State Leadership
Needed to Control Fraud and Abuse
scheme that was generating nearly $450,000 a month in fraud losses to
Medicaid. The scheme came to light once the shelter tipped off the state
Medicaid agency. Managed care plans can also engage in fraudulent
business practices similar to those in fee-for-service health care—such as
providing kickbacks for referrals or having unqualified personnel provide
services.
Fraud and abuse schemes also cross jurisdictional and program
boundaries, complicating the task of pursuing the perpetrators. In our
October 1999 correspondence on health care fraud, we noted that criminal
groups have created interstate health care fraud schemes and have used
associates in foreign countries to transfer ill-gotten proceeds out of the
United States. For example, a group with ties to a New Jersey scheme
purchased a lab in Illinois and began bilking Medicaid and Medicare there.
In another case, two individuals investigated for Medicaid fraud in south
Florida were tied to three individuals in North Carolina who used a similar
scheme to falsely bill Medicare. Proceeds from this scam were laundered
through associates in Mexico.
Medicaid Is Vulnerable to Certain characteristics of the program make Medicaid an attractive target
for exploitation, as follows:
Fraudulent and Abusive
Practices • As a third-party payer, Medicaid pays for services provided by others and
cannot, as a practical matter, police each claim for reimbursement
submitted. In a state like New York, the very size of the program invites
exploitation. In fiscal year 1998, New York’s Medicaid program, covering
roughly 2 million beneficiaries,3 cost an estimated $27 billion. Medicaid
consumes, on average, 20 percent of a state’s budget.
• The impermanence of the population, owing to beneficiaries’ changing
eligibility status, makes the program a target for such schemes as billing
for services provided to ineligible or deceased individuals.
• Because many states pay considerably less under Medicaid than providers’
customary charges, Medicaid providers are often in short supply. Thus,
program administrators are reluctant to impose controls that are
perceived as burdensome for fear of discouraging provider participation.
3Our data on New York’s beneficiary enrollment reflect calendar year 1998.
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Medicaid: Federal and State Leadership
Needed to Control Fraud and Abuse
Coordination, Our prior health care program integrity work has shown that strong
federal and state leadership is needed to ensure that three essential fraud
Prevention, and control elements are in place. First, the multiple agencies involved must
Adequate Resources Are coordinate their efforts effectively. Second, HCFA and the states must
focus on preventive strategies, since detection and prosecution efforts
Key Fraud Control alone cannot stem program losses. Finally, state agencies need the
Elements administrative and technical tools and resources to accomplish their
mission.
Coordination Essential, but Examples from our prior program integrity work underscore the
importance of coordinating the efforts of multiple law enforcement and
Difficult to Achieve oversight agencies. One of our reports focused on Medicaid prescription
drug diversion,4 often referred to as “pill-mill” fraud, in which physicians,
clinic owners, and pharmacists collude with willing beneficiaries by
fraudulently prescribing and distributing prescription drugs. In some
cases, pharmacists added medications to beneficiaries’ orders and kept the
extra for resale; clinics provided unneeded prescriptions to beneficiaries,
who would trade them for merchandise; and providers gave beneficiaries
prescriptions for drugs in exchange for their Medicaid number to bill for
services not provided. We noted that a drug diversion case could typically
involve five or more state, local, and federal agencies in its investigation,
prosecution, and resolution. Network diversion schemes could involve
third-party payers other than Medicaid, entrepreneurs, beneficiaries,
middlemen, and physicians not enrolled in Medicaid. Handling such
schemes could entail coordination between, for example, a MFCU in the
state’s department of law and other agencies with jurisdiction, such as an
office of professional medical conduct in the state’s department of health,
an audit office in the state’s department of social services, and an office of
professional discipline in the state’s department of education.
Two examples illustrate the payoff resulting from agency cooperation. One
is the FBI’s Operation Goldpill. Working with other federal agencies and
with state MFCUs and regulators, approximately 1,000 FBI agents
participated in the FBI’s largest health care undercover operation at that
time, involving 50 cities nationwide. This initiative reflected a new strategy
focusing on multidefendant conspiracy indictments rather than single-
defendant prosecutions. Through this effort, law enforcement agencies
were able to charge 254 defendants; seize $10.8 million in assets, including
11 pharmacies; and levy $6.6 million in fines.
4Medicaid Drug Diversion Fraud: Federal Leadership Needed to Reduce Program Vulnerabilities
(GAO/HRD-93-118, Aug. 2, 1993).
Page 7 GAO/T-HEHS-00-30
Medicaid: Federal and State Leadership
Needed to Control Fraud and Abuse
The second example—Operation Restore Trust (ORT)—represented a
cornerstone in recent health care fraud coordination, which focused on
Medicare and Medicaid fraud and abuse. ORT brought together the HHS
OIG and other federal, state, and local agencies to target wrongdoing by
home health, nursing home, and durable medical equipment providers,
initially in five states. In its first 2 years of operation, ORT identified $188
million in inappropriate payments. Among the lessons learned was the
importance of coordination among the various program and enforcement
agencies involved at the federal, state, and local levels. For example,
coordination between Medicare claims administration contractors and
state licensing inspectors in the project states resulted in the
decertification of many of the targeted home health agencies and the
recovery of substantial sums in inappropriate payments. Through the
Medicare contractors’ efforts to train state inspectors on specific billing
and beneficiary coverage issues, the inspectors were able to provide the
contractors information they might not otherwise have been able to obtain
on beneficiaries who were not eligible or home health agencies that billed
for services not provided. Through this mutual exchange of information,
contractors were able to identify an array of billing abuses costing the
government millions of dollars.
As obvious as the benefits are from interagency coordination, several
barriers exist that discourage such cooperative efforts. Among these are
the following:
• Labor-intensity of building a case with uncertain outcome. The level of
resources and interagency coordination required for case development
can stall the pursuit of a case at many junctures and delay the resolution of
a case for many years. The pursuit of fraud often begins with the state
Medicaid agency, which, to refer the case to a MFCU, must typically
prepare careful documentation through data analyses, claims audits,
interviews with patients, and medical record reviews. The MFCU may
reject cases because of its backlog, insufficient evidence, or estimated
dollar losses below a certain threshold. At the time of our drug diversion
study, one state’s MFCU typically rejected more than 90 percent of the
Medicaid agency’s fraud referrals because of staffing constraints. For
cases accepted, MFCU investigations can involve, among other things,
additional interviews or analyses of medical records and subpoena of
financial records. If the case enters federal jurisdiction, the MFCU may
forward the case to a U.S. Attorney. If the case is prosecuted and
convictions are obtained, further work also may be necessary to establish
administrative sanctions and recover overpayments.
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Medicaid: Federal and State Leadership
Needed to Control Fraud and Abuse
• Timing of actions to maximize administrative as well as criminal
sanctions. In our drug diversion study, we reported that the state agencies
and MFCUs made little effort to time audits and criminal investigations so
that civil recoveries could be made without compromising criminal
prosecution. When poor communication exists between a MFCU and the
state Medicaid agency, the state agency may be delayed in taking civil
action before the statute of limitations has expired. In such cases, the
agency may have to forgo the opportunity to assess monetary penalties or
obtain recoveries that can restore financial losses to the Medicaid
program.
• Competing productivity goals between agencies. One state’s MFCU
officials told us that a state Medicaid agency’s SURS unit, for example,
may be reluctant to classify cases as fraud. Fraud cases must generally be
referred to the state MFCU. Cases classified as overpayments generally
remain the within the SURS’ jurisdiction, and recoveries are credited to
the SURS’ performance results.
• Federal payback rules. Federal law creates a fiscal incentive for states to
avoid finding fraud.5 The law requires that the state pay back the federal
share of these overpayments within 60 days of discovery, regardless of
whether the state has recouped its losses.6
We are currently reviewing states’ efforts to enhance coordination in our
ongoing study for the Committee. In Georgia, the MFCU has established
working teams consisting of members from three state agencies—
prosecutors from the Attorney General’s office, investigators from the
Georgia Bureau of Investigation, and auditors from the Department of
Audits.
Prevention Is Key to Preventive strategies designed to stop improper activity before Medicaid
incurs losses is another essential control. Our observations on
Avoiding Program Losses coordination difficulties demonstrate that efforts to detect and prosecute
wrongdoing are important but are typically expensive and labor-intensive,
sometimes with little financial recovery to show for the effort. Consistent
with this view is HCFA’s philosophy “to pay it right” instead of paying and
chasing.
542 U.S.C. 1396b(d)(2)(C).
6While this requirement may be appropriate under ordinary circumstances so that states are
encouraged to seek recovery, it may not be appropriate in criminal cases in which recovery efforts
could damage the investigation by alerting the suspect.
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Medicaid: Federal and State Leadership
Needed to Control Fraud and Abuse
Preventive strategies can be embedded in the design of provider
enrollment procedures, payment methods, coverage policies, and
beneficiary eligibility verification. As we concluded from previous work,
states’ emphasis on developing preventive measures were well-placed
because efforts to recover losses were often unsuccessful. In our ongoing
study, we will examine states’ approaches to fraud control prevention.
One example—provider enrollment controls in the Medicare program—
illustrates how such approaches help avert fraud.
Until recently, when new requirements were established, Medicare
procedures for certifying home health agencies were seriously flawed. For
example, in a 1997 report,7 we noted that becoming a Medicare-certified
home health agency had been too easy, particularly in light of the number
of problem agencies that had been identified in past years. There had been
little screening of those seeking Medicare certification. For example,
Medicare certified an agency owned by an individual with no home health
experience who turned out to be a convicted drug felon and who later
pleaded guilty with an associate to having defrauded Medicare of over $2.5
million. Rarely did new home health agencies fail the program’s
certification requirements. HCFA has since developed procedures to
better scrutinize the qualifications and background of home health agency
applicants.
Adequate Resources An investment in adequate resources, consisting of qualified staff and
modern payment safeguard technology, is a third element essential to
Include Qualified Staff and effective Medicaid fraud and abuse control. Over time, health care fraud
Modern Technology schemes have become increasingly complex, frequently involving
networks of people, sophisticated computer techniques, and multiple
geographic locations. In a 1994 Medicare report,8 we focused on the
results of a HCFA demonstration examining the effect of additional
program safeguard funding. We found that the “demonstration”
contractors had achieved higher medical review savings than the control
group contractors because they committed more resources to improving
their analytic tools and hiring qualified technical staff.
In recent interviews, officials in several states have expressed concerns
that the lack of effective data systems has hampered their efforts to
identify fraud. For example, one state official said that the state’s Medicaid
7Medicare Home Health Agencies: Certification Process Ineffective in Excluding Problem Agencies
(GAO/HEHS-98-29, Dec. 16, 1997).
8Medicare: Greater Investment in Claims Review Would Save Millions (GAO/HEHS-94-35, Mar. 2,
1994).
Page 10 GAO/T-HEHS-00-30
Medicaid: Federal and State Leadership
Needed to Control Fraud and Abuse
automated detection system is 15 years old and not well designed for the
types of analysis needed today. Another official noted that the state lacked
a system to perform electronic prepayment screening of claims, a tool that
we have reported on in Medicare reports as a fundamental payment
safeguard. Reflecting these concerns, a MFCU official stated that service
data, staff capable of mining them, and state-of-the-art detection software
are important tools for fraud control. Our ongoing study will examine the
extent of states’ capacity to identify fraud or abuse.
HCFA’s Role in Medicaid In recent years, HCFA has taken steps to improve its program integrity
efforts in both Medicare and Medicaid. For Medicaid in particular, HCFA’s
Fraud Control role to date has been largely to facilitate training and information-sharing
efforts for the states.
In 1997, HCFA established the Medicaid fraud and abuse national initiative
designed to bring different components among and within states together
at meetings and to provide training, share information, and address
common concerns. As part of the initiative, individual committees have
been created to work on specific problems and solutions. For example, a
state legislation committee developed a database on a Web site that all
states can access that catalogues states’ program integrity legislation. This
serves states seeking models for anti-fraud-and-abuse legislation and
contacts for further information. A federal legislation committee has
developed proposals to increase state effectiveness that have been added
to HHS’ legislative proposals. HCFA has also formed and funded a
technical advisory group that meets regularly to discuss Medicaid program
integrity issues.
Despite HCFA’s positive efforts to facilitate states’ activities, we are
concerned about the agency’s efforts to ensure that all states have
effective program integrity strategies. In our June 1999 testimony on
Medicaid payments for school-based services, we raised concerns about
HCFA’s role as steward of Medicaid funds. We noted that the agency’s
regional offices, lacking specific guidance, were inconsistent in their
determinations of whether a given state’s practices for claiming
administrative costs were appropriate. Practices that HCFA had allowed in
one state had not been allowed in others, resulting in confusion. It also
created an environment in which school systems “pushed the envelope”
into the realm of questionable billing practices.
From this particular work we made observations that apply to Medicaid
fraud and abuse control in general. First, striking a balance between the
Page 11 GAO/T-HEHS-00-30
Medicaid: Federal and State Leadership
Needed to Control Fraud and Abuse
stewardship of Medicaid and the need for flexible approaches in dealing
with 50-plus Medicaid programs is difficult. However, mindful of that
balance, HCFA is in a position to explore, in partnership with states, the
appropriate level of commitment to preventing and detecting fraud and
abuse. We think this is important because both have a fiduciary
responsibility to administer Medicaid efficiently and effectively.
Mr. Chairman, this concludes my prepared statement. I will be happy to
answer any questions you or the Subcommittee Members may have.
GAO Contact and For future contacts regarding this testimony, please call Sheila K. Avruch
on (202) 512-7277. Key contributors to this testimony include Barrett W.
Acknowledgments Bader, Bonnie L. Brown, Hannah F. Fein, and Robert L. Lappi.
Page 12 GAO/T-HEHS-00-30
Related GAO Products
Financial Management: Increased Attention Needed to Prevent Billions in
Improper Payments (GAO/AIMD-00-10, Oct. 29, 1999).
Health Care: Fraud Schemes Committed by Career Criminals and
Organized Criminal Groups and Impact on Consumers and Legitimate
Health Care Providers (GAO/OSI-00-1R, Oct. 5, 1999).
Medicaid: Questionable Practices Boost Federal Payments for School-
Based Services (GAO/T-HEHS-99-148, June 17, 1999).
Fraud, Waste, and Abuse: The Cost of Mismanagement (GAO/AIMD-98-
265R, Sept. 14, 1998).
Nursing Homes: Too Early to Assess New Efforts to Control Fraud and
Abuse (GAO/T-HEHS-97-114, Apr. 16, 1997).
Medicaid Fraud and Abuse: Stronger Action Needed to Remove Excluded
Providers From Federal Health Programs (GAO/HEHS-97-63, Mar. 31,
1997).
Fraud and Abuse: Providers Excluded From Medicaid Continue to
Participate in Federal Health Programs (GAO/T-HEHS-96-205, Sept. 5,
1996).
Medicare and Medicaid: Opportunities to Save Program Dollars by
Reducing Fraud and Abuse (GAO/T-HEHS-95-110, Mar. 22, 1995).
Prescription Drugs: Automated Prospective Review Systems Offer
Potential Benefits for Medicaid (GAO/AIMD-94-130, Aug. 5, 1994).
Medicaid: A Program Highly Vulnerable to Fraud (GAO/T-HEHS-94-106,
Feb. 25, 1994).
Medicaid Drug Fraud: Federal Leadership Needed to Reduce Program
Vulnerabilities (GAO/HRD-93-118, Aug. 2, 1993).
(201006)
Page 13 GAO/T-HEHS-00-30
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Address Correction Requested
Medicaid: Federal and State Leadership Needed to Control Fraud And Abuse
Published by the Government Accountability Office on 1999-11-09.
Below is a raw (and likely hideous) rendition of the original report. (PDF)