Q&A of the Day – About Medicare and Social Security Fraud

Q&A of the Day – About Medicare and Social Security Fraud

Each day I’ll feature a listener question that’s been submitted by one of these methods. 

Email: brianmudd@iheartmedia.com

Twitter: @brianmuddradio

Facebook: Brian Mudd https://www.facebook.com/brian.mudd1

Today’s entry...

Love your radio show and commentaries.

Am sure that you receive Senator Rick Scott’s

Weekly notices - Week in Review- especially the report on Social Security, Medicare and Medicaid scams, fraud and corruption. If HE knows about this, I want to know WHY NOTHING is being said on news media outlets about the billions of tax payer dollars being sent out in Social Security, Medicare and Medicaid checks for fraudulent claims - specifically to those who are DECEASED? WHY is the Federal Government doing nothing to overhaul those two agencies, fire those in charge, replace with efficiency expert who can clean up the mess, stop the corruption and save the government BILLIONS? Also, WHAT can we, as citizens, DO about it?

Bottom Line: I hear your frustration loud and clear. First, it might be helpful knowing that there is an effort underway to crackdown and convict those who defraud these programs. In the prior year here’s what happened using federal records...

Medicare/Medicaid Fraud

  • 788 criminal cases successfully prosecuted 
  • 818 civil cases successfully prosecuted
  • $2.6 billion recovered from fraudulent activity

Social Security Fraud

  • 3,093 investigated cases
  • 404 criminal cases successfully prosecuted 
  • 42 civil cases successfully prosecuted
  • 1,679 scams stopped

Literally there are people being investigated, arrested and prosecuted every day for defrauding these programs. The less than optimistic news, which is what Senator Rick Scott was highlighting, is that it’s a small percentage of what’s known to have happened. Take the Medicare and Medicaid fraud for example. The estimated amount of fraud for the prior year was $60 billion. The amount recovered through prosecutions was $2.6 billion. That’s a 4.3% success rate. Meaning that just over 95% of fraud was successfully carried out by those doing it. 

In terms of what you can do, there’s quite a bit you can personally do if you suspect fraud. The second most common way investigations are opened is through private citizens reporting concerns. This can be done online through the Office of Inspector General: 

Social Security




Otherwise, part of the problem we have is the size of these departments and programs themselves. With over 100 million Americans on these programs, they’re going to be hard to manage no matter what. In retail businesses, an average of 1.5% of all activity is shrinkage, or stolen goods. That should be a number that’s a benchmark for the government as well. Instead, with Medicare it’s estimated to be about 10% and with Social Security I calculated fraud at only 0.4%. In other words, the Social Security Administration seems to be doing really well at managing against fraud while Medicare and Medicaid is doing a terrible job. That should be an area of increased focus for our federal government. So yes, advocating to your elected representatives about the need for accountability and reform is probably needed. Senator Scott having it on his radar is a start.

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