Medicaid funds, particularly those from matching state coffers, often take the lion’s share of taxpayer subsidized healthcare costs of coverage for individual states’ poor, disabled, young, and pregnant citizens. With the explosion in “alternative”^[1] arenas of care for many in those populations, the ability for states to oversee the potential for fraudulent billing and waste is stretched to unassailable limits — often resulting in a mode of “catchup” to stop Medicaid fraud’s ever-expansive reach throughout states’ already fragile healthcare economies. Truly, Medicaid’s characterization as a mechanism for social protection — rather than public insurance — is explicit and is easily manipulated by unscrupulous and unregulated (non-state) third parties which can easily exploit limited state resources (safety nets). At least Louisiana appears to be applying some much needed influence by cracking down on many unregulated “care entities” after noting an almost 25% overbill rate (!) from various home care agencies. | LINK

1. Non-traditional scenarios for the care of patients with chronic disability, often operating under limited or no certification from licensing authorities [↩]

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