Medicaid: A Program Highly Vulnerable to Fraud (Testimony, 02/25/94,
GAO/T-HEHS-94-106).

The Medicaid program cost state and local governments more than $150
billion in 1993 for health services and supplies.  It is highly
vulnerable to fraud because of its size, structure, target population,
and coverage.  The ensuing drain on program funds is hard to gauge, but
state Medicaid officials believe it may be as high as 10 percent of
program expenditures.  Prescription drugs are a very appealing target.
Schemes include pharmacists routinely adding medications to customers'
orders and clinics inappropriately giving Medicaid recipients completed
prescription forms, or scrips, that can be sold on the street to the
highest bidder.  Some pills costing 50 cents at the pharmacy have been
resold for as much as $85.  Although states have been tackling Medicaid
fraud with some success, the problem persists.  Officials in many states
say that most leads go unpursued, cases take too long to resolve, and
penalties are light even for those convicted.  Most say that a lack of
resources hinders oversight, investigations, and prosecutions. GAO
suggests that the Health Care Financing Administration take the lead and
develop an overall strategy to guide states in their struggle against
Medicaid fraud.

--------------------------- Indexing Terms -----------------------------

 REPORTNUM:  T-HEHS-94-106
     TITLE:  Medicaid: A Program Highly Vulnerable to Fraud
      DATE:  02/25/94
   SUBJECT:  Medicaid programs
             Fraud
             Program abuses
             State-administered programs
             Drug trafficking
             Internal controls
             Interagency relations
             Monitoring
             Health care costs
IDENTIFIER:  Florida
             Arizona
             Kentucky
             Michigan
             Minnesota
             New York
             Oregon
             
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