The Federal and State governments share the cost of Medicaid. Fraud, waste, and abuse in Medicaid drain taxpayer dollars and cause improperly high payment rate. Modern Healthcare reported (2015) that in 2014, the government reported nearly $80 billion misspent on Medicaid and Medicare. New York City is an example of local government struggling with Medicaid fraud; New York Times (2005) suggests that 40 percent of NYC’s Medicaid payments are “questionable”. Most of the reporting protocols are optional, and because reporting information consumes already-limited resources, many states choose not to report. Centers for Medicare and Medicaid Services (CMS) oversee the healthcare programs at the federal level. Recent legislation passed by Congress …show more content…
CMS applies the new technology to focus on fraud detection and provider enrollment (Ted Doolittle, 2010). The recent Time magazine (2016) report on an arrest of 275 people nationwide of a crackdown on Medicaid and Medicare fraud seems to explain a progress on implementing the new legislation. As the implementation runs in a slow speed and many flaws have been found by Office of Inspector General (Muchmore, 2016), Lawmakers question the CMS performance and suggest a reform Base on Medicaid data (CMS, 2016), since 2013, Medicaid enrollment has increased 25 percent with the implement of the Affordable Care Act (ACA) in 2010. Under the ACA, new eligibility requirements allow individuals who make less than $16,000 to enroll in government-sponsored health insurance without using asset test, which was previously used to determine eligibility in regular Medicaid; thus, …show more content…
Policymakers intend to introduce reforms, such as time limits and work requirements, to help break the generational cycle of dependency and encourage people moving up the economic ladder. Instead of welfare, a “workfare” hypothesis theory is