In a scheme mirroring the “corrupted retailer” scheme seen in SNAP, fraud in Medicaid is on a massive scale; transnational criminal organizations (TCOs) partner with or establish dishonest medical providers and durable medical equipment provider (DME) companies, or diagnostic laboratories.

The corrupt provider submits electronic claims stating they performed complex genetic testing, physical therapy, or telemetry monitoring on hundreds of synthetic ghost patients….

CMS’ recent push for states to revalidate high-risk Medicaid providers is a clear signal: program integrity scrutiny is increasing.

As states work to meet these expectations, Medicaid managed care organizations may be asked to support significant provider validation activity, including site inspections, licensure verification, and operational reviews………