Delivering health and human services is among the largest and most important responsibilities of state and local government. As such, these services often comprise the largest portions of state and local budgets. Medicaid alone processes 3.9 billion claims each year, representing more than $430 billion paid annually for more than 57 million beneficiaries, and that volume of payments creates the greatest opportunity for fraud, waste and abuse in government. Thus, the difference between fraud, waste and abuse remains that of intent. Despite intent, fraud, waste and abuse still costs state and local government billions. Data analytics offer great promise in abating fraud, waste and abuse in the delivery of health services.
With Medicaid’s improper payment rate averaging 8.4 percent since 2008, the program has accrued over $161 billion worth of improper payments. Agency leaders and senior officials across the country count fraud, waste and abuse among their primary challenges in policy implementation.