 LTC Bullet: Long-Term Care Fraud Friday, July 24, 2026 Seattle— LTC Comment: LTC fraud is large and growing especially in the public sector, which could learn from the private sector’s better identification and control methods. We announce a new Center report on LTC fraud, after the ***news.*** *** illumifin, the leading insurance third party administrator (TPA) and longtime Center-corporate member, inspired and assisted our work on LTC insurance fraud. The company’s excellent presentations on LTCI fraud at the 2025 Intercompany LTC Insurance Conference last March pointed the direction for our research. Executive Chairman Peter Goldstein encouraged our study and Jeffrey Ferrand, Vice President of Fraud Services at illumifin, provided helpful advice and suggestions. We thank the company and its officials for the path-breaking work they’ve done to identify, prevent, and prosecute the various forms of fraud confronting the long-term care insurance industry. ***
LTC BULLET: LONG-TERM CARE FRAUD LTC Comment: Today, the Center for Long-Term Care Reform published a new report titled “Long-Term Care Fraud.” Its “Executive Summary” and “Conclusion” follow below but you can check out the complete report here. Long-Term Care Fraud by Executive Summary Health care fraud is large already and growing rapidly. Long-term care (LTC), vital because of America’s aging population, is especially susceptible to fraud. Government or corporate third parties finance most LTC which creates a moral hazard by facilitating fraud and reducing its risk. Individuals, naturally averse to fraud, fund much less LTC out of their own pockets. Most LTC is delivered in private homes without supervision inviting fraudulent billings. We know the incidence and cost of fraud in private LTC insurance. But there is no published measure of LTC fraud in the public sector. Medicaid and Medicare present special problems that make LTC fraud identification, processing and prosecution exceptionally difficult. The Trump administration has undertaken a major push to reduce public sector health care fraud. Private sector advances to control LTC fraud could help reduce obstacles on the public side. A key is prioritization, focusing on cases most likely to produce results. This paper examines LTC fraud in both sectors and recommends measures to curtail its growth and impact. … Conclusion LTC fraud is inevitable in a health care system that relies heavily on third-party payment, limited supervision, and complicated public administration. As demand for LTC grows with population aging, the chances for phantom billing, upcoding, identity abuse, and organized fraud expand unless payers respond more aggressively. Private LTC insurers have identified and reduced fraud by using targeted investigation, risk scoring, and early intervention instead of waiting to recover losses after the fact. Public programs, especially Medicaid and Medicare, face greater barriers, but they could employ the most effective private-sector practices more aggressively. Focus on high-risk claims; use data analytics to stop suspicious payments earlier; and prioritize cases with the greatest return on investigative effort. In a system where most LTC spending comes from third parties, fraud control will always depend on incentives. Replacing Medicaid’s wide open federal funds matching system with capped block grants would encourage states to focus more vigorously on fraud control. Absent the temptation of unlimited federal revenue, state Medicaid programs would more effectively protect vulnerable recipients, preserve public funds, and maintain trust in long-term care. |