Is more Medicaid fraud committed by providers than beneficiaries?

The majority of Medicaid fraud is committed by providers. Fraud by beneficiaries, like selling prescription drugs or sharing a Medicare card, occurs less frequently and tends to be smaller in scale.  

Common types of Medicaid provider fraud include upcoding, a practice that involves billing for a more expensive service than was provided, and submitting false claims, such as for diagnoses a patient does not have or services that were not provided. 

Over the past several years, a network of behavioral health facilities in Arizona defrauded the state Medicaid program, the Arizona Health Care Cost Containment System (AHCCCS), of up to $2.5 billion in taxpayer dollars. The facilities recruited unhoused populations and Native Americans, ultimately charging Medicaid exorbitant fees for services that were inadequate or not provided at all.