From a legislative audit report in another state:

According to the National Health Care Anti-Fraud Association, the majority of health care fraud is committed by providers. One of the most common types of fraud, according to the OIG, is billing for services that were never rendered. This could occur when a provider knowingly bills Medicaid for a treatment or procedure that was not actually performed, such as blood tests when no samples were drawn or x-rays that were not taken. Because the distinction between error and fraud rests on intent, then the same activity (such as use of incorrect codes) could result from either error or fraud.
Other common types of provider fraud include
- billing for more expensive services or procedures than were actually provided or performed (“upcoding”),
- performing medically unnecessary services,
- misrepresenting services provided (for example, billing a covered procedure code and providing a non-covered service),
- accepting kickbacks for patient referrals, and
- submitting separate bills for services that should be billed in combination, such as tests or procedures that are required to be billed together at a reduced cost (“unbundling”).

Although both fraud and abuse involve intentional action, fraud may be committed without any services being rendered. In contrast, abuse involves the provision of health care. Abuse is defined as actions by providers or recipients that are “inconsistent with sound fiscal, business, or medical practices” and that result in unnecessary cost. Examples of abuse include
- billing and receiving payment from a recipient for the difference between the provider charge and the Medicaid reimbursement for the service,
- billing Medicaid a higher fee than private pay patients, and
- excessive charges for services or supplies.

This is going on in all states. Meanwhile, most people think Medicaid Fraud means undocumented aliens receiving medical care or the like. The vast majority of Medicaid fraud and abuse, by dollar amount or by number of fraudulent bill submissions, are from providers (doctors, clinics, etc.) trying to game the system.

Unsurprising. Corporations in healthcare can figure out how to cut costs en masse by underserving when they are paying and by slightly, but routinely, over-treating when they are paid by the procedure. Studies on physician-owned hospitals compared to the next-nearest hospital show clear results of over-ordering lab tests, procedures, referrals to affiliated specialists, admissions, and surgeries.

Evidence-based medicine exists for many situations where research has clearly shown a best-practices course of treatment for a typical patient with "hypothetical disease". When doing a root canal and a crown on a baby tooth, the child's dental situation must be pretty exceptional, or these dentists have too much time free on their appointment sheets. Which is probably true, as too many dentists are graduating as opposed to RN's, and allied technologists and medical personnel who don't make the same annual incomes as dentists, but who are needed in huge numbers, and require long, technical educations.

This is a great article, the kind of thing I would miss if not for Truthout.