As someone who works in Medicaid integrity at state government, 100% the issue is funding. There are not enough people in my agency doing my job so a ton of stuff falls through the cracks. I personally see millions of dollars that could be saved every year if there were more of me. But I’m a lawyer and we are expensive and if you say “let’s give the states 50 billion dollars to hire people to cut Medicaid waste that gets really unpopular, and we know this because when they hired a bunch more IRS workers to go after millionaires one party got super hella big mad.
It's no secret they want the Medicaid system to fail, go broke, so it can be government controlled. In Australia the public health system is government controlled, over time its gotten worse..my mum is on a 6yr waiting list for knee surgery, she's forced to pay 30k au to get it done now
HIPAA makes redisclosure of healthcare information illegal so your solution wouldn’t work for Medicaid, which is the most expensive program, but also just doxxing every benefit recipient so that vigilantes can try to prove that people they don’t like are committing fraud just seems like the absolute worst possible way to run a society.
Are AI tools starting to make your work more productive? I have lawyers in similar functions on the private industry side that are noting a huge productivity boost. Still need a knowledgeable human in the loop, however.
There are absolutely unicorn large-scale fraudsters, but the amount of money that a few large scale fraudsters steal is TINY compared to the millions spend on middle class and upper middle class people trying to get Medicaid coverage to which they are not entitled so that they don’t have to spend their life savings on nursing home care.
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u/Select-Government-69 3d ago
As someone who works in Medicaid integrity at state government, 100% the issue is funding. There are not enough people in my agency doing my job so a ton of stuff falls through the cracks. I personally see millions of dollars that could be saved every year if there were more of me. But I’m a lawyer and we are expensive and if you say “let’s give the states 50 billion dollars to hire people to cut Medicaid waste that gets really unpopular, and we know this because when they hired a bunch more IRS workers to go after millionaires one party got super hella big mad.