Centers for Medicare & Medicaid Services Administrator Dr. Mehmet Oz said the United States is facing a growing crisis involving personal care services and Medicaid fraud, pointing to federal data that he said shows unusual billing trends in Pennsylvania and other states.

Speaking during a presentation on healthcare fraud, Oz said the rapid growth in personal care services has raised concerns nationwide and prompted officials to closely examine enrollment figures and Medicaid spending.

"Now we're facing a personal care services crisis around the country," Oz said.

"The surge in enrollment of individuals in these in programs is stunning, so shocking. We have to double check our numbers. We don't think it's possible it is happening, but it is."

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Oz said the personal care industry has become one of the largest employment sectors in several states.

"In California, New York, the number one job in the entire state is personal care services," he said.

"Guess what? It's good to be home because it's true in Pennsylvania too. 50% dramatic more people serving in the personal care services space-that's home care-that is in retail. That's where Pennsylvanians are going. It's becoming a jobs program."

According to Oz, the increase in spending has also been accompanied by significant Medicaid fraud that harms both taxpayers and patients.

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"Medicaid fraud in the state is costing taxpayers for care that was never delivered, or even worse, harmful," Oz said.

"It's costing patients their health, their trust in a system-a system that was built in a high-trust environment, a place we all thought that we would be able to be safe."

He questioned why anyone would exploit vulnerable Americans who depend on Medicaid services.

"Because who would steal from the poor?" Oz asked.

"As Colin outlined, many people unfortunately are doing just that, and we're coming after them."

Oz described the alleged fraud as a serious breach of trust between caregivers and patients.

"What we're exposing today is a diabolical breach of trust, a violation of the sacred bond between patient and caregiver," he said.

"It is a catastrophe that can only be dealt with in the way we'll be outlining for the rest of this presentation."

He then outlined several examples from cases announced that day, saying investigators uncovered instances in which Medicaid was billed for services that could not have been provided.

"Today's defendants included an aide who billed Medicaid for care claimed to be delivered while they were in jail, or while they were being arrested, or while they weren't in the country," Oz said.

"The list goes on and on, one more disbelievable than the next."

Oz also referenced allegations involving a home care agency.

"And it's not just individuals. There's a home care agency, two owners who are charged with billing Medicaid hundreds of fabricated clock-ins. Again, care that was never delivered at all, and we have evidence of that."

He said CMS is focused on ensuring Medicaid dollars reach the intended recipients.

"CMS's job is to make sure this money reaches the people who actually need it," Oz said.

"That's the grandmother who desperately needs this money to stay out of a long-term care facility. It could be a vet who relies on this to get help because he's stuck in bed. All these individuals deserve our love and support, not the criminals who have hurt them."

Oz then cited federal data that he said shows Pennsylvania stands out nationally in several Medicaid spending categories.

"We've reviewed Pennsylvania's personal care billing trends. I'm going to give these numbers to you slowly because they're really important," he said.

"This is the federal government's data on Pennsylvania."

According to Oz, "Pennsylvania ranks fifth nationally in average monthly payments, both per beneficiary and per provider. That is way out there. Be number five in both those categories. More expensive that is in 45 states."

He also pointed to the state's billing descriptions.

"Over 96% of personal care claims here are illness unspecified. That's how they're titled. So we can't track them. It doesn't help if the U.S. attorney or the attorney general can't possibly find the fraud because people aren't actually telling us what they're really doing."

Oz said the reporting system must change to improve oversight.

"We have to change that that that history that's evolved here into the norm."

He added that Pennsylvania's average payment per beneficiary exceeds $50,000.

"And finally, average payments per beneficiary more than $50,000. Think about that: 50,000 per person getting home care in the state, on average, far above what you'd ever expect. All this points to fraud."

Oz said those findings demonstrate why cooperation across multiple government agencies is necessary.

"The cases like these are exactly why a whole government approach is so critical, and why we have to develop best practices of how to evolve this system."

He said Medicaid Director Dan Bilman would also discuss autism care services in Pennsylvania, which Oz said have experienced unusually high spending.

"He's going to touch on another problem that's a big one in Pennsylvania, which is autism care services, and why they're again not only are they off the chart in Pennsylvania, but the rest of the country."

Oz said CMS is providing states with tools to identify suspicious billing practices and distinguish legitimate claims from fraudulent ones.

"But we are actually here to help. We're giving you a toolkit that will allow the state to be able to tell what's good, what's not, what's foul, what's fair, so we can identify the best use of our funds."

He concluded by linking the increase in healthcare fraud to changes that occurred during the COVID-19 pandemic.

"Yesterday, I was in Maine. We're investigating home support services, just like you're seeing here for adults in that case who have autism," Oz said.

"Medicaid spending the top 10 providers there has dramatically increased over the last six years."

"In fact, across the board, if you look at fraud in healthcare, all gone up in the last six years. What happened in 2020 that has catalyzed this? What has allowed this corruption to be weaponized? It's COVID. COVID appears to have unleashed massive fraud through grifters because criminals knew the federal government would not follow up on the money that was spending out. We we told the world we were open for fraud, and they could start harpooning us with their spears."

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