Connect with us


Waste of the Day: $38.5 Billion In Medicaid Funds Improperly Managed

Medicaid spent $389.5 billion in 2022 with too little oversight in how the States are managing the payouts.

Print Friendly, PDF & Email



Loose cash lots of Benjamins lost to PPP fraud in Illinois alone

Topline: State governments spent $38.5 billion to increase Medicaid payouts in 2022, but there is little oversight of how the money is being used, according to a U.S. Government Accountability Office report.

Key facts: Typically, state governments send money to Medicaid Managed Care, which pays healthcare centers on behalf of patients as needed.

But since 2017, states have been allowed to send extra money directly to clinics to try and improve the quality of healthcare. The practice was originally meant to be used sparingly, but it’s becoming more common.

Waste of the Day: $38.5 Billion In Medicaid Funds Improperly Managed
Waste of the Day 2.27.24 by Open the Books

State governments spent over $38.5 billion on these “directed payments” in 2022, which are managed by the Centers for Medicare and Medicaid Services.

But according to the GAO, there are “weaknesses” in “CMS procedures for approving such payments.”

The report says that CMS has “weak fiscal guardrails,” meaning states often do not keep track of whether a healthcare provider is using its funds effectively before sending it more money.


The GAO evaluated five states and found that none of them were “consistently” evaluating whether the extra billions of dollars spent on Medicaid were actually having an impact on patient outcomes. In Texas, some hospitals received more than double the standard amount of funds, with little to no oversight.

The causes of this issue varied. Some states had flawed data software; some were simply not “implementing best practices.”

CMS also has not set any clear limits on the amount of money a single healthcare provider can receive.

Background: Eighteen states each spent over $500 million on directed payments in 2022, with California and Texas each giving out almost $7 billion.

Most of the money came from taxes on private healthcare providers, while some came from state general funds and other sources.


The United States spent $804 billion on Medicaid overall in 2022.

Summary: States are gaining more influence every year over how Medicaid funds are dispersed, yet they don’t have enough systems in place to prevent potential wasteful spending.

The #WasteOfTheDay is brought to you by the forensic auditors at

This article was originally published by RealClearInvestigations and made available via RealClearWire.

Print Friendly, PDF & Email
CEO at | Website | + posts

Adam Andrzejewski (say: Angie-eff-ski) is the CEO/founder of Before dedicating his life to public service, Adam co-founded HomePages Directories, a $20 million publishing company (1997-2007). His works have been featured on the BBC, Good Morning America, ABC World News Tonight, C-SPAN, The Wall Street Journal, The New York Times, USA Today, FOX News, CNN, National Public Radio (NPR), Forbes, Newsweek, and many other national media.

Today, is the largest private repository of U.S. public-sector spending. Mission: post "every dime, online, in real time." In 2022, captured nearly all public expenditures in the country, including nearly all disclosed federal government spending; 50 of 50 state checkbooks; and 25 million public employee salary and pension records from 50,000 public bodies across America.

The group's aggressive transparency and forensic auditing of government spending has led to the assembly of grand juries, indictments, and successful prosecutions; congressional briefings, hearings, and subpoenas; Government Accountability Office (GAO) audits; Congressional Research Service (CRS) reports; federal legislation; and much more.

Our Honorary Chairman - In Memoriam is U.S. Senator Tom Coburn, MD.

Andrzejewski's federal oversight work was included in the President's Budget To Congress FY2021. The budget cited his organization by name, bullet-pointed their findings, and footnoted/hyperlinked to their report.

Posted on YouTube, Andrzejewski's presentation, The Depth of the Swamp, at the Hillsdale College National Leadership Seminar 2020 in Naples, Florida received 3.8 million views.

Andrzejewski has spoken at the Columbia School of Journalism, Harvard Law School and the law schools at Georgetown and George Washington regarding big data journalism. As a senior policy contributor at Forbes, Adam had nearly 20 million pageviews on 206 published investigations. In 2022, investigative fact-finding on Dr. Fauci's finances led to his cancellation at Forbes.

In 2022, Andrzejewski did 473 live television and radio interviews across broadcast, major cable platforms, and radio shows. Andrzejewski is the author of The Waste of the Day column at Real Clear Policy. The column is syndicated by Sinclair Broadcast Group, owners of nearly 200 ABC, NBC, CBS, and FOX affiliates across USA.

Andrzejewski lives in Hinsdale, Illinois with his wife Kerry and three daughters. He is a lector at St. Isaac Jogues Catholic Church and has finished the Chicago Marathon eight times (PR 3:58.49 in 2022).


Would love your thoughts, please comment.x