Bad Synergy: Consultants Score $1.5 Billion from Medicaid

Open The Books ^ | 8/9/26 | Open The Books

[spintreebob]

Taxpayers are unknowingly paying private consultants a cut of the Medicaid money the consultants help states claim for school-based health services.

Federal auditors have flagged more than $1.5 billion of those claims as improper or unsupported across four states, and the consultant was the same in every one: Boston-based Public Consulting Group (PCG). New Jersey’s audit states the firm was hired “on a contingency fee basis,” and the Government Accountability Office has found consultants building school Medicaid claims collected fees of 3 to 25 percent of the federal reimbursement. The more school-staff time coded as “Medicaid,” the bigger the check.

While that money moves between consultants, state agencies, and Washington, Americans are waiting for paychecks to hit to buy groceries and pay rent or hoping for a tax return to help cover the rising costs of daily life.

Two decades after the federal government was warned about the arrangement in writing, the same failures repeat across states and almost none of the flagged money has come back.

Hidden Fees: By the Numbers The documented scope of the hidden Medicaid fees are established via auditing practices: $551.4 million flagged in Pennsylvania, $439 million in New York, $606.7 million in New Jersey, and $954,408 in Michigan. That amounts to $12.16 for every household in the United States, according to Federal Reserve data.

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TOPICS: Business/Economy; Crime/Corruption; Government; News/Current Events
KEYWORDS: hiddenfees; medicaid

[spintreebob]

In GA the high profile role of PCG is to cover for the FRAUD of Deloitte, the much bigger fraudster than PCG. Provides advice to state staff navigating complex federal CMS requirements. My contact with them was hearing how to develop Medicaid to be more complex, requiring more consultants like them. It was not about better healthcare to Medicaid members. It was not about efficiency and what is best for the taxpayers or GA economy.

[mewzilla]

Pigs at the trough...

[Steely Tom]

That’s a lotta synergy.

[neverevergiveup]

There is so much ‘peripheral money’ being paid in the health care sector that increases prices and doesn’t enhance patient care. I don’t have time right now to elucidate, but it’s a lot.

[oldtech]

So...It looks like the eastern states are busily robbing the rest of us. Looks like are part of the problem that just adds more & more to our already huge deficit. Wish we could take direct action every time something like this is discovered.

[dennisw]

These consultants are grifting off the Federal tit same as the blue states that they consult for. Dialed in Democrat consultant scum, that enable the blue states to steal even more from Medicaid and Medicare.

[thinden]

In GA the high profile role of PCG is to cover for the FRAUD of Deloitte, the much bigger fraudster than PCG. Provides advice to state staff navigating complex federal CMS requirements. My contact with them was hearing how to develop Medicaid to be more complex, requiring more consultants like them. It was not about better healthcare to Medicaid members. It was not about efficiency and what is best for the taxpayers or GA economy.

xxxxxxxxxxxxxxx

so, how much is PCG kicking up the the pols that gave birth to this scam of taxpayer money?

[Red Badger]

[spintreebob]

Eastern states? Deloitte is the #1 Fraudster. It is in most states, Red and Blue, all the big states... CA TX FL GA TN KY IL WI MI PA NY etc. It is also the enabler of most fraud by others.

Accenture Consultants taught me: If the client is centralized, recommend de-centralized. If the client is de-centralized, recommend centralization. Whatever the client is, recommend the opposite, that will generate the most billable hours.

HHS followed this under Biden and (so far) RFK/OZ have not changed that inefficiency. GA welfare has 2 main contracts: Deloitte IES Integrated Eligibility System for Medicaid, WIC, SNAP, WIC, TANF, Sec8, LIHEAP, etc and GAINWELL for Medicaid.

Following the Accenture/BIDEN HHS advice GA Medicaid has spent many millions on a plan to decentralize GAINWELL’s contract into many smaller contracts to other vendors (whose H1b have no idea how to do it).

None of the decentralization of GAINWELL addresses the major defects of welfare execution in GA, which are
1) Deloitte is a fraud
2) Way too much money has been spent on DEI because the way too many voices have way too many subjective axes to grind in how to represent DEI in the software.
3) Address in all welfare programs is an expensive mess.
4) Medicaid providers are allowed to bypass the software system.

[neverevergiveup]

You obviously have a different and more extensive set of experiences with consultants than I do, but our experiences are fully congruent if not overlapping. I witnessed consultants come into a university hospital system in California, fire a significant number of people in short order (escorted out with little time to do anything but leave), and instructing staff (doctors, nurses, administrators, etc.) to report on anyone they noted criticizing the hospital system. It would have made 'state' propagandists' in the USSR, CCP, North Korea, Nazi Germany etc. proud.

Ultimately, the hospital system had to replace many positions they eliminated, didn't make anything better or save money, but got paid a fortune. When they left they also left a number of 'observing consultants' behind to assess things going forward. Their salaries added up to millions more.

[T-Bird45]

You could have just stated that the system hired “The Bobs” from Office Space, given the work style.

[MrBambaLaMamba]

How do I get in on that scam I mean gig?

[gildafarrell]

Dang! This is outrageous.