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NEW REPORT: Three Ways Republicans Distort Medicaid Data

Nov 17, 2020

Washington, D.C.— Yesterday, the Department of Health and Human Services (HHS) released new financial data, including information on Medicaid improper payments. To combat disingenuous and harmful claims by Republicans and Medicaid opponents, the House Budget Committee has released a report breaking down the data and debunking common attacks used to undermine the integrity of the Medicaid program.

“Republicans know supporting program integrity and state IT systems leads to billions of dollars in federal savings but instead of advocating for these investments, they continue to distort federal data in an attempt to justify their efforts to cut a program that provides critical health coverage for millions of Americans,” said House Budget Chairman John Yarmuth. “Medicaid has become an even more vital lifeline for American families during the COVID-19 pandemic and resulting economic collapse. The last thing Americans need right now is another Republican attack on their health care.”

The report summarizes three key facts about Medicaid improper payments and debunks common Republican attacks: 1) Improper payments are not the same as fraud; 2) Most improper payments occur because states or providers did not follow rules and are not the fault of Medicaid beneficiaries; and 3) The eligibility component of the Medicaid improper payment metric only captures a piece of the eligibility picture.

Key Data Points:

  • Medicaid provides health insurance to nearly 69 million people – or roughly one in five Americans. When the Children’s Health Insurance Program (CHIP) is included, the number rises to more than 75 million Americans.
  • Only a small fraction (just 9 percent in FY 2020) of Medicaid improper payments reflect payments the federal government should not have made in the first place. The data make clear that, contrary to Republican claims, actual fraud in Medicaid is quite rare.
  • Over one-fifth of all Medicaid improper payments are due to a state procedural mistake: noncompliance with certain provider screening and enrollment rules.
  • HHS reported that only 3 percent of improper payments were deemed improper because the beneficiary was ineligible for the program or service provided, and some of those cases may represent accidental errors made by patients or providers rather than intentional fraud.
  • Through the Medicaid Integrity Program, CMS works with states to reduce improper payments and fraud, waste, and abuse. In 2018, these efforts resulted in a federal savings of $1.3 billion in Medicaid and CHIP.
  • Every dollar invested in the Health Care Fraud and Abuse Control (HCFAC) program returns about $4.20 in federal taxpayer dollars.

Report can be viewed here. PDF version available here.