Crowdsourcing accountability

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MYRNA BROWN, HOST: It’s Thursday the 5th of March.

Glad to have you along for today’s edition of The World and Everything in It. Good morning, I’m Myrna Brown.

MARY REICHARD, HOST: And I’m Mary Reichard.

First up, the War on Fraud.

Days after President Trump announced the war on fraud, Vice President J.D. Vance pinpointed a major focus in combating waste and abuse of taxpayer dollars.

VANCE: The main source of fraud, whether it's a small business or a bigger company, is you have people who are billing the government millions, 10s of millions, billions of dollars, saying that they're providing a service, but there's no actual confirmation. There’s no followup.

BROWN: The Department of Health and Human Services halted funds to Minnesota and a handful of other vulnerable programs. And Centers for Medicare and Medicaid Director Dr. Mehmet Oz then called on Americans to join the investigation.

OZ: We want your input on how to prevent, detect and respond to fraud for in government funded health care. Whatever ideas you have, we're interested in.

REICHARD: What can Americans do to help fight fraud?

Washington Producer Harrison Watters has the story.

HARRISON WATTERS: Right before Valentine’s Day, a team at the Department of Health and Human Services made an elaborate gesture, and it didn’t involve flowers.

FOREST PARK PHARMACY: DOGE dumped all the Medicaid data online for everyone to see.

FOX BUSINESS: You can scroll through seven years worth of data for procedures billed, claims submitted and how much Medicaid paid out.

More than two hundred million rows of data, representing individuals and organizations in all fifty states seeking reimbursement for services provided to low income Americans.

One in five Americans are on government assisted healthcare plans. Medicaid alone cost $618 billion in 2024. And HHS wants to minimize any fraud associated with such programs.

After reports of widespread daycare and autism services billing fraud in Minnesota, HHS responded by clamping down on reimbursements to the state. Now the administration is moving forward with a plan to bring in more help.

ANDERSON: We finally have another partner in looking for the fraud, with the American public.

Hannah Anderson is Senior Director of Policy at the America First Policy Institute. She also served on HHS Secretary Robert F. Kennedy Jr.’s transition team. She says while the Department of Government Efficiency was focused on cutting costs for HHS, officials have also been compiling internal data to release to the public.

ANDERSON: It takes one click to download the dataset. And you can start searching by provider. You can start searching by, what kind of services are costing the most, and really start tracking and trying to figure out, is that provider in LA County actually providing the services that they're supposed to be providing to Medicaid, or are they using Medicaid fraud to enrich themselves?

The Medicaid dataset only shows provider data—no patient information is included, for privacy reasons. The providers range from billion dollar companies to mom and pop transportation services.

The government already has several departments devoted to investigating and prosecuting fraud. But Anderson says Medicaid has some unique flaws prompting the government to invite more scrutiny.

ANDERSON: Medicaid, , is a partnership between the states and the federal government. So if a state has decided that they're going to send in bad or fragmented data, or they're not going to take it on themselves to be identifying fraud, it gets even harder for CMS, to find that fraud.

HHS told WORLD that allowing access to the information “will help identify unusual increases in specific treatments.” The dataset covers 2018 to 2024—a time when the government dramatically expanded access to Medicaid during the COVID-19 pandemic.

EKIN: …because of the urgency, we weren't able to necessarily do our due diligence.

Tahir Ekin is Professor of Analytics at Texas State University, and author of the 2019 book Statistics and Healthcare Fraud. He says the Medicaid dataset is a helpful starting point for finding red flags.

EKIN: So, for instance, some providers might have billed more than 24 hours per day. So there are those like impossible scenarios that basically any person could track by using their favorite Gen AI tool these days.

But Ekin has a warning as Americans begin mining the data: He says although some numbers look suspicious, not all overspending is fraudulent, and cautions it requires subject matter expertise to tell th difference.

EKIN: We really need to validate those results, and sometimes those false red flags may have bigger consequences, because obviously there is reputation at stake.

Vice President Vance told WORLD that restoring the money that’s been lost to fraud, waste, and abuse is a complicated task.

VANCE: There are certainly ways to claw some of the money back. It depends on the circumstances of the case. When you're talking about hundreds of billions of dollars, potentially in fraud, that's that's a big universe of cases.

Professor Ekin says investigators are likely to get back just a fraction of what’s been lost.

EKIN: Even if we find fraud, even if we validate it within context, traditional numbers put the recovery as 10 cents over $1. So we will only be able to get 10% of the lost money back.

Meanwhile, Ekin says true fraudsters are getting more sophisticated in their schemes, as generative AI tools get better and cheaper.

EKIN: From the government side, we need to be also proactively getting ready, knowing that there are really smart actors out there. And whenever we do an adjustment, they do an adjustment as well.

For now, policy analyst Hannah Anderson is hopeful HHS and the American public will shine a light on where taxpayer dollars are going.

ANDERSON: Having transparency and whether it's posting it on the internet or following, like the prescribed channels to report, report fraud. But you know, sunshine is the best medicine.

Reporting for WORLD, I’m Harrison Watters, in Washington.

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