Things are so bad, there are reports of Miami-area drug dealers who have gone into Medicaid/Medicare fraud instead. Lower risk, less chance of being caught, few prison terms handed out. The way this fraud usually works is, the criminal buys a list of social security numbers/Medicare numbers and bills the government for goods and services never rendered. Durable Medical Equipment is a perennial favorite, presumably because one does not need any medical credentials to provide these devices.
And that doesn't even begin to deal with the problem of overbilling or furnishing substandard care to patients, (One example of this is abusive dental practices that target Medicaid kids and drill each and every tooth, destroying the kid's mouth, without any need.)
I'm not an expert on fraud prevention at the billing level, but obviously changes need to be made to the enrollment process for providers....much tighter controls need to be in place as to who gets a billing number. Outright fraud, like a "phantom patient list" should bring on a long prison sentence and overbilling should at least result in claw back of the unearned funds.
There are various disincentives to effective investigation and prosecution, as well as punishment. Many in law enforcement are oriented towards drug crimes and cannot see the need to punish a "white collar crime". Others are frankly not trained for these cases, as the methods of proof and so are are vastly different from a drug case. There's a POV that these cases are not "sexy", won't get an investigator or prosecutor anywhere career-wise and take far too long to complete.
IMO, both Medicare and Medicaid need their own investigators and possibly a staff of prosecutors. Some of the criticism about handling an insurance case is fair...it's a different skill set from a violent or drug crime case.
