Catching up on the fraud

like most folk, I have been busy with my family over the holidays, and now am catching up on the big story of the week: The Somali immigrants have found a new way to make money: but as DOGE found out, this is just the tip of the iceburg on stealing/diverting government money:

My lower bound guess for how much fraud there is nationally is ~20% of the Federal budget, which would mean $1.5 trillion per year. Probably much higher. https://t.co/T6URzaqHqY

— Elon Musk (@elonmusk) December 29, 2025

 posted for watching later on my tablet: Dilbert discusses fraud in the news:

.....

🚨 Here is the full 42 minutes of my crew and I exposing Minnesota fraud, this might be my most important work yet. We uncovered over $110,000,000 in ONE day. Like it and share it around like wildfire! Its time to hold these corrupt politicians and fraudsters accountable

We ALL… pic.twitter.com/E3Penx2o7a

— Nick shirley (@nickshirleyy) December 26, 2025

 this is not of course limited to Somalis or the Democratic operatives. Nor is it limited to daycare centers... And it is in many states. 

As a physician I know that Medicare/medicaid/insurance billing fraud has been widespread for years.

so I asked Grok to summarize billing fraud identified from clinics in recent years: (And remember:  a lot of the fraud is never caught):

link from Grok

Medicaid fraud by clinics involves providers billing state Medicaid programs for services that were never provided, medically unnecessary, substandard, or involving illegal kickbacks. This exploits vulnerable populations (e.g., those needing addiction treatment or mental health services) and drains taxpayer funds.

 Fraud types include phantom billing, upcoding, kickbacks for patient referrals, and billing for unlicensed care.

Historical Context

Medicaid fraud enforcement dates back to the 1970s, with Medicaid Fraud Control Units (MFCUs) established in states starting in the late 1970s to investigate provider fraud and patient abuse/neglect. Federal oversight by the HHS Office of Inspector General (OIG) and DOJ has intensified since the 2000s via Health Care Fraud Strike Forces. Early cases often involved nursing homes and home health, but clinics (e.g., pain, mental health, substance abuse) became prominent in the 2010s–2020s, especially with opioid epidemic-related schemes.

Improper payments (including but not limited to fraud) have declined over time due to better detection: Medicaid's improper payment rate fell from ~15.6% in 2022 to ~5.1% in 2024 (mostly paperwork errors, not fraud). Recoveries by MFCUs reached ~$1.4 billion in FY 2024, with trends showing increased focus on criminal cases.

Hmmm.  did the improper payment rate really fall that much over a two year period:  from ~15.6% in 2022 to ~5.1% in 2024 , or was it overlooked or missed? Just wondering.... 

Notable Cases Involving ClinicsClinics, especially substance abuse, mental health, and pain management facilities, have featured in major cases:

2025 Arizona Scheme — A billing executive conspired with 41 addiction treatment clinics to bill Arizona Medicaid ~$650 million for unprovided or worthless substance abuse services, targeting Native Americans. Part of the DOJ's record $14.6 billion national takedown. 

Kentucky Opioid Clinics (2025) — Owners of addiction treatment facilities fraudulently billed Medicare/Medicaid >$8 million for non-performed or misrepresented services. 

New York Suboxone Clinic (2025) — A clinic owner billed ~$85 million for unnecessary services and improper narcotics prescribing. Other Examples — Cases include kickbacks for unnecessary urine testing, billing for unlicensed mental health care (e.g., $25 million Massachusetts settlement), and schemes in Minnesota involving recruited patients for unprovided services. Trends and EnforcementFraud schemes have evolved toward telehealth, kickbacks, and transnational networks. Enforcement has ramped up, with annual DOJ takedowns charging hundreds and recovering billions. MFCUs recover ~$3–$4 per $1 spent on investigations, with 2024 seeing record criminal recoveries. While fraud exists, most improper payments stem from administrative issues, not intentional deceit.Medicaid remains a high-priority target for fraud prevention, with ongoing efforts to enhance detection and protect vulnerable beneficiaries.

Heck, it isn't even new: The reason Jesus overthrew the tables in the Temple was because of fraud, overcharging and kickbacks to the Temple staff.