Deliver nothing, blame someone else.
Thanks to lax oversight, insurers have quietly pocketed $4.3 billion in duplicate Medicaid payments over the last three years. The scheme isn’t complicated: a patient moves, signs up for Medicaid in a new state, and both states keep paying the insurer. One patient, one set of services, two payouts.
Meanwhile, providers delivering that care must fight for reimbursement. Not for double coverage, just for doing their jobs. And per usual, payors walk away with the bag while hospitals drown in denials and red tape.
Insurers Get Paid. Providers Get Played.
Centene alone took in $620 million in these double payments. Elevance followed with $346 million. UnitedHealth cashed in at $298 million. And that’s just three of over 270 insurers who took part.
We can imagine their excuses would look something like:
“It’s not our job to check eligibility.”
“We’re just following the rules.”
“We sometimes return the money later.”
(Translation: We’ll give it back… if you catch us.)
This isn’t accidental. It’s the same old script: profit first, accountability later. When payors get caught double dipping, they blame the state. When hospitals ask for reimbursement, they shift the burden. When patients need care, they pile on the paperwork.
This is not a glitch. It’s the model.
Providers Are Bleeding While Insurers Get Fat
While insurers double dip, providers are losing money treating Medicaid patients at all. Medicaid already reimburses hospitals at just 78% of what it actually costs to care for a patient. That’s before the delays. Before the denials. Before the administrative limbo of petitioning for payments insurers already received.
- Children’s hospitals rely on Medicaid for nearly half their patient population.
- Safety nets are scraping by with razor-thin margins.
And despite providing life-saving care, expanded access points, and medical cures, providers are left footing the bill. They’ve been underpaid while insurers double up and point the finger elsewhere.
So, What Now? It’s Time to Stop Playing Nice
Insurers receive two payrolls, can deliver next to nothing, and shrug it off. Hospitals deliver care, oftentimes lose money, and get gaslit. Providers can’t keep waiting for these system glitches to fix themselves.
- Call it what it is. This isn’t a slip up. It’s revenue theft. Healthcare consumers must understand that every unpaid claim or underpayment risks a reduction in services, a provider laid off, or a patient denied care.
More insurer schemes are coming into the limelight, and policymakers should continue to stay watchful.
- Close the loopholes. Medicaid’s oversight structure is broken, patching it with duct tape won’t cut it. Enact real-time, cross-state enrollment tracking and demand transparency from insurers on where their money comes from (and where it’s not going).
- Put teeth behind the rules. If an insurer takes double payments, they should pay it all back with penalties. Not a quiet clawback, not a PR statement. Real accountability, in public view.
Bottom line: Insurers didn’t make a mistake; they made a business decision. It’s time to flip the script because the only thing worse than payors swindling the system is letting them get away with it.
