by James C. Sherlock
Federally-funded programs administered by the states are primary targets of fraud and abuse because of the vast sums at stake. The amount of money at risk is literally unimaginable. Medicare and Medicaid alone exceed two trillion dollars a year.
Federal programs are widely victimized in Virginia because the Commonwealth does not defend them well. The Commonwealth recovers millions of dollars. Billions escape.
State defenders against fraud in many federally funded programs run by the Commonwealth have a too-narrow focus. Actively hampered by the General Assembly, they are ignoring the forest as they examine the trees.
States operate their own programs under federal and state guidelines for:
- administering Medicaid,
- licensing and overseeing providers of healthcare and of assistance to people with intellectual and developmental disabilities (I/DD);
- managing unemployment insurance systems. Those are funded through a joint federal-state partnership financed by employer payroll taxes — state unemployment taxes (SUTA) for benefits and federal unemployment taxes (FUTA) for administration.
- conducting public assistance programs for the needy that are largely funded by the federal government. Major programs like SNAP (food assistance) and TANF (cash assistance) are funded by the federal government but managed at the state level.
In Virginia and other states, there are four lines of defense against program fraud, waste, and abuse:
(more…)
