Because states run programs like Medicaid, but the federal government pays for over half of it, states have the incentive to come up with new programs and less incentive to properly police Medicaid spending.
“state and federal prosecutors have been trying to bust fraudulent preschools and other Medicaid fraud schemes in Minnesota for more than a decade. And yet, there are always more. Law enforcement is doing its best, but the problem seems to be that the state’s welfare bureaucracy is doing a terrible job of stopping the scammers in the first place.
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This is not just a problem in Minnesota either. Medicaid fraud is remarkably common. The federal departments of Justice and Health and Human Services run a joint program to catch fraudsters, and in 2024 alone it accounted for 1,151 convictions that recovered almost $1.4 billion.
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Anyone who wants to stop Medicaid fraud should focus less on scoring partisan political points or demonizing immigrants and more on the boring work of fixing federal policy.
Telling states to pay for a larger share of their own Medicaid spending seems like an obvious step in the right direction. It would give state officials—from governors like Walz all the way down to the lowest-ranking bureaucrat—a stronger incentive to prevent waste and fraud in the first place. It would reduce the burden placed on out-of-state taxpayers when states with lax enforcement allow fraud like this to occur.”