Law Articles

Return to Law Dictionary Index

Medicaid Fraud & Abuse and General Information

This site is intended to provide information and materials of interest to both consumers and professionals about Medicaid fraud and abuse. The Centers for Medicare & Medicaid Services (CMS) is committed to fighting fraud and abuse, which divert dollars that could otherwise be spent to safeguard the health and welfare of Medicaid clients.

Although the states are primarily responsible for policing fraud in the Medicaid program, CMS provides technical assistance, guidance and oversight in these efforts. Fraud schemes often cross state lines, and CMS strives to improve information sharing among the Medicaid programs and other stakeholders.

Medicaid is the largest source of funding for medical and health-related services for people with limited income. The average number of Medicaid enrollees in 2003 was estimated to be about 41.9 million, the largest group being children (19.3 million or 46 percent). In 2001, 12.5 percent of the population was enrolled in the Medicaid program.

More than 46 million people received health care services through the Medicaid program in FY 2001 (the last year for which beneficiary data are available). In FY 2003, total outlays for the Medicaid program (Federal and State) were $278.3 billion, including:

- Direct payments to providers of $197.3 billion,
- Payments for various premiums (for HMOs, Medicare, etc.) of $52.1 billion,
- Payments to disproportionate share hospitals of $12.9 billion, and
- Administrative costs of $16.0 billion.
- Outlays under the SCHIP program in FY 2003 were $6.1 billion. With no changes to either program, expenditures under Medicaid and SCHIP are projected to reach $445 billion and $7.5 billion, respectively, by FY 2009.

The related links below will provide you with technical assistance and guidance to support you in your ongoing effort to fight against fraud and abuse: State Contacts; Fraud State Statutes; and Medicaid Guidance and Reports. Additional assistance can be found at the related links below: Medicare.gov - "How to Report Medicare Fraud" and the Office of Inspector General (OIG) - Fraud Prevention and Detection".

For more information

Return to Criminal Law

Return to Law Dictionary Index