While the Centers for Medicare & Medicaid Services continues its efforts to “crush” Medicaid fraud, a new report says that the biggest source of improper Medicaid payments is…

Flawed paperwork.

While improper payments generally are categorized as fraud, waste, and abuse, CMS’s focus has been squarely on fraud.  At the same time, however, the Congressional Research Service recently reported that flawed paperwork, and not necessarily an attempt to inappropriately or illegally profit from Medicaid payments, is most of the problem.

According to the report,

CMS estimates that most improper payments (77% in FY2025) are the result of insufficient documentation (e.g., failing to submit documentation for a Medicaid enrollee who is eligible for the medical service) rather than fraud or abuse.

The report does not minimize the problems of fraud, waste, and abuse, noting that

The total amount of Medicaid fraud is unknown. State Medicaid Fraud Control Units (MFCUs) reported recovering $2 billion from criminal and civil cases in FY2025. CMS reported that program integrity activities for Medicaid and the Children’s Health Insurance Program (CHIP) saved the federal government $1.5 billion in FY2024.

Learn more from the Congressional Research Service report “Medicaid Program Integrity: Background and Resources” and the Becker’s Hospital Review article “77% of Medicaid improper payments tied to paperwork, not fraud: Report.”