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Medicaid Fraud and Abuse for Professionals

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. Medicaid is the largest source of funding for medical and health-related services for people with limited income.

More than 46.0 million persons 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 State Children's Health Insurance Program (SCHIP) 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.

Although 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.

The Medicaid Guidance and Reports link, on the left-hand navigation bar, will provide you with technical assistance and guidance to support you in your ongoing effort to fight against fraud and abuse. For fraud state statutes, state contacts, and state legislative web sites, click on the Fraud State Statutes link below. 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.

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