Report: Medicaid Misspent $4.3 Billion in Duplicate Payments

Taxpayers spent at least $4.3 billion over a three-year period covering the same Medicaid patients twice, The Wall Street Journal reported Thursday. 

Medicaid paid health insurance companies for hundreds of thousands of patients who signed up for the program in two or more separate states. This happened when a patient moved to a different state but Medicaid continued paying the insurance company in the state where the resident previously lived. 

Medicaid is a joint state and federal health insurance program for the poor. Medicaid pays private insurance companies for each person covered. However, a person isn’t supposed to be covered in a state after moving out.

The Journal reported that from 2019 to 2021—which included the COVID-19 pandemic—duplicative payments for an average of about 660,000 patients per year totaled $4.3 billion, and more than 270 Medicaid insurers collected duplicate payments. 

Medicaid paid Centene $620 million in duplicative payments between 2019 and 2021. Elevance Health collected $346 million from duplicate Medicaid payments, the newspaper added. Medicaid paid UnitedHealth Group $298 million.

“Paying for a beneficiary’s Medicaid coverage in one state when that individual is already enrolled in a different state is a prime example of taxpayer dollars being mismanaged,” a spokeswoman for the federal Centers Medicare and Medicaid Services told the Journal. 

The spokeswoman added the agency will work with states to address the matter.

President Donald Trump’s nominee to run the federal agency, Mehmet Oz, previously said he would rein in large payments to private insurers.

An insurance industry group said it’s up to states to verify eligibility. 

“It’s a heavily regulated industry,” Craig Kennedy, chief executive of Medicaid Health Plans of America, told the Journal. “Following rules and regulations is the No. 1 priority here.”