Do taxpayers know how much government fraud and inefficiency they are paying for? Hopefully DOGE can clean up these duplicate (and sometimes triplicate and more) payments. If the Wall Street Journal is capable of finding multiple payments, then surely the government itself can find and stop them.
(p. A1) Health insurers got double-paid by the Medicaid system for the coverage of hundreds of thousands of patients across the country, costing taxpayers billions of dollars in extra payments.
The insurers, which are paid by state and federal governments to cover low-income Medicaid recipients, collected at least $4.3 billion over three years for patients who were enrolled—and paid for—in other states, a Wall Street Journal analysis of Medicaid data found.
The patients were signed up for Medicaid in two states at once, in many cases following a move from one to the other. Most were getting all their healthcare services through one insurer in one state, even though Medicaid was paying insurers in both states to cover them.
Private insurers oversee Medicaid benefits for more than 70% of the about 72 million low-income and disabled people in the program. The companies get paid each month for each person they cover. They aren’t supposed to get paid if a patient leaves for another state.
. . .
(p. A9) The Journal’s analysis turned up some cases in which individuals were signed up in five or more states.
. . .
The Journal’s analysis used detailed Medicaid data, obtained under a research agreement with the federal government, to identify duplicate payments to managed-care companies. The analysis examined where double-enrollees got their medical care each month, using that as an indication of their state of residence.
. . .
“There is very little incentive for the managed-care organization to check eligibility,” said industry consultant Kevin Bagley, the former director of Nebraska’s Medicaid program. Bagley and other Medicaid experts said it is difficult for states to claw back payments from managed-care companies for covering relocated enrollees, largely because it can be unclear exactly when they left.
Sometimes a single insurance company covered the same person in more than one state. During the period covered by the Journal’s analysis, Centene insured about 25,000 people a year, on average, in two different states at the same time. For those people, the company was paid at least $151 million extra. Elevance received $48 million extra for covering the same person twice, and UnitedHealth got $53 million.
One Centene supervisor urged some of the company’s case managers in February to keep Medicaid recipients enrolled after they moved. “Please DO NOT close cases when you learn a member has moved out of state,” the supervisor said in a Microsoft Teams message. “If the member shows eligible and are out of state, they can still can [sic] utilize some of the benefits.”
Centene’s spokesman said the company is required to maintain coverage for members until the state decides whether to disenroll a beneficiary.
The inspector general for the federal Department of Health and Human Services examined the issue of double payments several years ago in a study looking only at people enrolled in multiple state-paid managed care plans in August in 2019 and 2020.
The results led the team of investigators to conclude that taxpayers were wasting about $1 billion a year, said John Hagg, assistant inspector general for audit services at the oversight agency.
“It should be low hanging fruit,” said Hagg. “The data is there showing it is a problem. This is ripe for correction.”
For the full story see:
(Note: ellipsis, and bracketed date, added.)
(Note: the online version of the WSJ article has the date March 26, 2025, and has the title “Taxpayers Spent Billions Covering the Same Medicaid Patients Twice.” The passages quoted above omit the subheadings that appear in the print, but not the online, version of the article.)