$50 Billion in Medicare Waste? That's an Understatement.

There is $50 billion a year wasted in the Medicare program. That’s a billion dollars a week.

At an April 11 town hall, presidential candidate Tim Ryan of Ohio made the above statement in response to a question about how he would stop the federal government from wasting taxpayer money. Politifact investigated his statement and found it to be “mostly true.”

Specifically, Politifact reviewed testimony from a GAO director of audit services, who noted $48.5 billion in improper payments by Medicare for fiscal year 2018. Politifact determined that Ryan’s statement was mostly true because approximately $7 billion of that amount consisted of underpayments, and so that money was hardly “wasted” - rather only $45 billion of overpayments were made in that year.

Still, this amount is far from accurate. First, Politifact correctly noted that this amount is only what was caught. As one expert stated, “the audit protocols that Health and Human Services uses to produce the estimates are weak, ‘so the actual levels of overall waste, or overpayments, are undoubtedly much higher than these government estimates.’” False Claims Act whistleblowers report fraudulent schemes in the hundreds of millions of dollars that slip by CMS auditors.

Second, the amounts likely do not include fraud resulting from violations of the Stark Law or Anti-Kickback Statute, which can result in overprescribing of drugs and services in exchange for kickbacks, or for providing services that are not medically necessary or reasonable. For example, Bracker & Marcus LLC recently settled an $84.5 million kickback scheme with a hospital group. Third, this statement does not include fraud on other government healthcare programs such as Medicaid, Tricare, or the VA.

If anything, Ryan understates the amount of fraud, waste, and abuse committed against Medicare, which is shocking when he is already talking about a fifty billion dollar annual problem.

Bracker & Marcus LLC is part of the solution. We represent whistleblowers in healthcare fraud cases and have helped to recover tens of millions of dollars for the Medicare program. If you are aware of Medicare fraud, please contact us today.