The federal government will withhold $1.3 billion in Medicaid payments to California due to potentially fraudulent billing patterns, Vice President JD Vance announced yesterday.
Analysis of Medicaid billing patterns in California aroused suspicion, according to Dr. Mehmet Oz, administrator of the Centers for Medicare and Medicaid Services.
“We’ve discovered $630 million in billing from folks who are egregiously the top 5 percent of outliers in billing,” Oz told reporters.
California itself is an outlier among states, Oz said, spending double at double the rate of other states for home health services.
The withholding is technically a deferral, so the payments could be made if the spending is found to be legitimate.
Vance also announced a push to enlist states to partner with the federal government on fraud enforcement by actively prosecuting fraud cases.
All states have federally funded Medicaid Fraud Control Units, but some do not appear to prosecute criminal cases involving fraud, Vance said.
“If they do not aggressively prosecute Medicaid fraud, we are going to turn off the money that goes to these anti-fraud units,” Vance said.
These are the latest in a string of anti-fraud efforts.
The government yesterday halted new Medicare provider enrollments for hospices and home health agencies, which it considers to be at high risk for fraud.
On April 23, Oz told states to develop a plan to revalidate the eligibility of Medicaid providers offering services at high risk of waste, fraud, and abuse.
Officials said they have identified billions in fraudulent or potentially fraudulent spending, leading to actions such as deferring $259 million in payments to Minnesota.
On April 15, the Centers for Medicare & Medicaid Services suspended payments to 773 hospices and 23 home health agencies based in Los Angeles that are suspected of fraud.
“We would be able to double the life expectancy of the Medicare Trust Fund if we could deal with the fraud issues, just in Medicare,” Oz said.
Vance said both Democratic and Republican-led states are being looked at in the administration’s anti-fraud campaign, citing Maryland and Ohio.
“There are a lot of governors, Democrat and Republican, who recognize that this is a very serious problem, that we’re offering resources to try to help solve that problem,” Vance said.
Oz said Minnesota has been less cooperative, having sued unsuccessfully to prevent the deferral of funding earlier this year.
“We are concerned that some governors see these programs as jobs programs, and the downstream impact of that resembles political patronage that we’re very serious about,” Oz said.
—Lawrence Wilson
BOOKMARKS
The Senate confirmed Kevin Warsh as head of the Federal Reserve on Wednesday, in a 54–45 vote. Warsh has regularly advocated for a “regime change” of policy and personnel at the Fed.
After 133 years, Princeton is scrapping its Honor Code—which allowed students to take exams without being watched by a proctor—due to an increase in cheating through AI. “The ease of access of these tools on a small personal device” has made cheating harder to observe, a memo by Dean of Faculty Gene Jarrett says.
President Donald Trump said on May 13 that he will ensure the release of all remaining political prisoners from Venezuelan jails. He also praised the nation’s leader, Delcy Rodriguez, who announced in January that more than 600 prisoners had been released.
The Senate tried again on Wednesday, but failed to pass a resolution to end the war in Iran. It was a bit closer this time, a 50–49 vote.
Members of the House have gathered the necessary support to bypass House leadership, and force a vote on a bill granting fresh aid to Ukraine. Find out what’s in the bill by reading Jackson Richman’s latest.
—Stacy Robinson
