Medicaid oversight needed to save care for others
Medicaid’s $860 billion price tag includes a publicly unacknowledged, staggering cost: the billions siphoned off each year by a small cadre of dishonest providers. After two decades building fraud-detection software for 21 states, I’ve learned that the problem is not struggling patients — it’s the minority of equipment suppliers, home health companies, ambulatory surgical centers, labs, hospitals, etc. that game the system.
State audits routinely uncover nightmares: dentists performing 14 “baby-tooth” root canals per child, ambulance companies billing thousands of phantom rides, nursing homes ordering enough incontinence supplies for all residents, not just Medicaid enrollees. These aren’t anecdotes; they are patterns that flourish because oversight is weak and, often, politically inconvenient.
Chasing every ineligible enrollee is ineffective. The average enrollee costs between $5,000 and $10,000 per year. A single abusive provider can drain that much in a week from the program. Data analytics can spot outliers quickly: a physical therapist who bills the maximum visits for every patient, a doctor who is magically in three distant clinics on the same day, a pharmacy “refilling” and billing for drugs that nobody collects.
What’s missing isn’t technology but will. Local officials fear losing the only doctor in town; powerful lobbies shield their own; managed-care plans simply fold questionable payments into next year’s premiums. Congress should tie a slice of federal funding to measurable anti-fraud performance and fortify whistleblower rewards. States must insulate investigators from political interference.
Harvard’s Malcolm Sparrow estimates that real oversight could cut Medicaid losses by 30%-35%. That would preserve care for the vulnerable and lighten the taxpayer’s load without dropping a single eligible patient.
GERRY HILL, ROSWELL
President is out of bounds on tariffs
When it comes to tariffs, the president has made headlines by threatening, setting, changing and pausing them repeatedly. Sometimes, these moves bring relief; other times, they cause panic and send the markets tumbling. But here’s what everyone needs to know: It’s not up to the president to set tariffs. Our Constitution gives that power to Congress, not the White House.
Yes, Congress can give the president some emergency authority in rare cases, but that’s not what’s happening here. The courts have already said the president’s actions on tariffs are out of bounds. Yet, most news reports skip over this basic fact, making it seem normal for a president to ignore the Constitution regarding tariffs. That’s dangerous. Since when did breaking the law become acceptable?
If this continues, Americans will be the ones who pay, either through higher prices or losing access to products we rely on. If Congress won’t step in and court orders are ignored, the only thing left is for the American people to raise their voices. We must speak up, join together and demand an end to this disregard for the law. Our democracy depends on citizens who care enough to stand up and protect it.
JEFF JOSLIN, ATLANTA
Cuts to NWS could be catastrophic
It doesn’t take a genius to see the direct impact of President Donald Trump’s funding cuts to the National Weather Service. Texas was our first victim.
Now, what’s going to happen during this year’s hurricane season?
It could be catastrophic. But unfortunately, that’s what so many enlightened voters asked for. And that’s just the tip of the proverbial iceberg.
D.C. VARN, ATLANTA
Keep Reading
The Latest
Featured
